Provider Demographics
NPI:1902175730
Name:ALIVA HEALTH & WELLNES CENTER, A NURSING CORPORATION
Entity Type:Organization
Organization Name:ALIVA HEALTH & WELLNES CENTER, A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, PHN, NP
Authorized Official - Phone:310-710-1723
Mailing Address - Street 1:420 EAST 3RD STREET
Mailing Address - Street 2:SUITE 810
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1647
Mailing Address - Country:US
Mailing Address - Phone:213-625-0717
Mailing Address - Fax:213-625-0770
Practice Address - Street 1:420 EAST 3RD STREET
Practice Address - Street 2:SUITE 810
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1647
Practice Address - Country:US
Practice Address - Phone:213-625-0717
Practice Address - Fax:213-625-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6531163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6531Medicaid