Provider Demographics
NPI:1992883037
Name:CREDIDIO, VIVIAN FERNANDEZ (PHD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:FERNANDEZ
Last Name:CREDIDIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:806 MANHATTAN BEACH BL
Mailing Address - Street 2:STE 207
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-376-3388
Mailing Address - Fax:310-372-0198
Practice Address - Street 1:806 MANHATTAN BEACH BL
Practice Address - Street 2:STE 207
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-376-3388
Practice Address - Fax:310-372-0198
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical