Organization
VIVID MED SPA, PROFESSIONAL CORPORATION
Active
Other names
Vivid Med Spa & Laser Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RIA PRAKASH JIVAN RN (CEO)
(903) 363-5914
Entity
Organization
Contact information
Practice address
166 E GOBBI ST, UKIAH, CA 95482-4918
(707) 414-0419
Mailing address
166 E GOBBI ST, UKIAH, CA 95482-4918
(707) 414-0419
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
03/09/2026
Last updated
03/09/2026
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