Provider Demographics
NPI:1104091966
Name:MICHAEL R.P. VIVIAN, MD
Entity type:Organization
Organization Name:MICHAEL R.P. VIVIAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RP
Authorized Official - Last Name:VIVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-650-3888
Mailing Address - Street 1:260 MAPLE CT STE 205
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9134
Mailing Address - Country:US
Mailing Address - Phone:805-650-3888
Mailing Address - Fax:805-650-3804
Practice Address - Street 1:260 MAPLE CT STE 205
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9134
Practice Address - Country:US
Practice Address - Phone:805-650-3888
Practice Address - Fax:805-650-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG788902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG78890Medicare PIN