Provider Demographics
NPI:1427254374
Name:GAZZONI, VIVECA ELISABETH (PTA)
Entity type:Individual
Prefix:
First Name:VIVECA
Middle Name:ELISABETH
Last Name:GAZZONI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:VIVECA
Other - Middle Name:ELISABETH
Other - Last Name:SOTOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 S BREA BLVD
Mailing Address - Street 2:#802
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5368
Mailing Address - Country:US
Mailing Address - Phone:714-257-1317
Mailing Address - Fax:
Practice Address - Street 1:1277 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2407
Practice Address - Country:US
Practice Address - Phone:562-501-9010
Practice Address - Fax:562-697-0421
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPAT 8041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPAT 8041OtherPTA LICENSE