Organization
LA VIDA HEALTH & WELLNESS CENTER OF GARDEN GROVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE PEREZ DE TAGLE (CEO)
(310) 962-4808
Entity
Organization
Contact information
Practice address
12062 VALLEY VIEW ST STE 108A, GARDEN GROVE, CA 92845-1737
(805) 233-6419
Mailing address
12062 VALLEY VIEW ST STE 108A, GARDEN GROVE, CA 92845-1737
(805) 233-6419
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
—
—
Other
Enumeration date
08/30/2023
Last updated
08/30/2023
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