Provider Demographics
NPI:1255160768
Name:MONTOYA, VIVIAN (DACCHM, LAC)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:DACCHM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4715
Mailing Address - Country:US
Mailing Address - Phone:213-858-1418
Mailing Address - Fax:424-378-5120
Practice Address - Street 1:4323 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4715
Practice Address - Country:US
Practice Address - Phone:213-858-1418
Practice Address - Fax:424-378-5120
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20104171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist