Organization
VIVANTI WOUND SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENT GERALD MOLINA BAGNI (CEO)
(909) 206-7657
Entity
Organization
Contact information
Practice address
1619 W GARVEY AVE N STE 205, WEST COVINA, CA 91790-2147
(909) 206-7567
Mailing address
1619 W GARVEY AVE N STE 205, WEST COVINA, CA 91790-2147
(909) 206-7567
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
—
—
Other
Enumeration date
06/04/2025
Last updated
06/04/2025
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