Provider Demographics
NPI:1073288718
Name:VIDA AVANTI MEDICINE
Entity type:Organization
Organization Name:VIDA AVANTI MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:424-390-7606
Mailing Address - Street 1:3013 KEELING AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-3015
Mailing Address - Country:US
Mailing Address - Phone:842-566-2214
Mailing Address - Fax:
Practice Address - Street 1:3350 E 7TH ST # 519
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5003
Practice Address - Country:US
Practice Address - Phone:424-390-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty