Provider Demographics
NPI:1023243052
Name:PHI, VIVIAN
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:PHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6047 JOAQUIN MURIETA AVE
Mailing Address - Street 2:APT. E
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-8516
Mailing Address - Country:US
Mailing Address - Phone:510-498-8283
Mailing Address - Fax:
Practice Address - Street 1:310 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6526
Practice Address - Country:US
Practice Address - Phone:510-869-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI59268106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist