Provider Demographics
NPI:1538285622
Name:AIZPURU, VIVIAN KO (MFT)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:KO
Last Name:AIZPURU
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SANTA CLARA DR STE 145
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3500
Mailing Address - Country:US
Mailing Address - Phone:916-779-2434
Mailing Address - Fax:916-588-2880
Practice Address - Street 1:1624 SANTA CLARA DR STE 145
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3500
Practice Address - Country:US
Practice Address - Phone:916-779-2434
Practice Address - Fax:916-588-2880
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist