Provider Demographics
NPI:1699926543
Name:VIVALDA, JULIE MARLENA (CNM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARLENA
Last Name:VIVALDA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 HEALTH CENTER DR., SUITE 620
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:657-241-8270
Mailing Address - Fax:657-276-4737
Practice Address - Street 1:24411 HEALTH CENTER DR., SUITE 620
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:657-241-8270
Practice Address - Fax:657-276-4737
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1820367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW1820OtherMEDICAL LICENSE