Provider Demographics
NPI:1902065402
Name:SUAYA, VIVIANA AMELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:AMELIA
Last Name:SUAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10436 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE #3005
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-474-3550
Mailing Address - Fax:310-474-9131
Practice Address - Street 1:10436 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE 3005
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-474-3550
Practice Address - Fax:310-474-9131
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA525162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry