Individual
MS. JENNIFER L VIVANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
11239 TAMPA AVE STE 205, PORTER RANCH, CA 91326-3782
(818) 831-0484
(818) 832-9389
Mailing address
11239 TAMPA AVE STE 205, PORTER RANCH, CA 91326-3782
(818) 831-0484
(818) 832-9389
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT20306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PT0203060
—
CA
Enumeration date
12/18/2006
Last updated
02/24/2020
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