Provider Demographics
NPI:1003791369
Name:VALLORINI VIVACQUA, FELIPE (DDS)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:VALLORINI VIVACQUA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 S BEVERLY GLEN BLVD APT 324
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6147
Mailing Address - Country:US
Mailing Address - Phone:310-920-9126
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2014
Practice Address - Country:US
Practice Address - Phone:310-920-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist