Provider Demographics
NPI:1437407830
Name:VIVO, RACHEL (CMT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:VIVO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16322 GAINSBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6156
Mailing Address - Country:US
Mailing Address - Phone:909-270-8605
Mailing Address - Fax:909-548-2845
Practice Address - Street 1:12960 CENTRAL AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4166
Practice Address - Country:US
Practice Address - Phone:909-627-1067
Practice Address - Fax:909-548-2845
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist