NPIMap

Organization Active NPI

La Vida Multi-Specialty Medical Group

  • Specialist
  • San Pedro, CA
National Provider Identifier
1285789487
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
476247-04 Issued in CA
Legal business name
LA VIDA MULTI-SPECIALTY MEDICAL GROUP
Practice address
605 W. 6TH Street
San Pedro, CA 90731
Phone
(310) 241-0330
Fax
(310) 241-0719
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Christopher C Chidi, MD
Title
President
Phone
(310) 214-8677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 476247-04 CA Primary

Addresses

Primary practice location

605 W. 6TH Street
San Pedro, CA 90731

Mailing address

Department No 2834
Los Angeles, CA 90260
Phone (310) 214-8677

Other identifiers 1

IdentifierTypeStateIssuer
GR0088194MedicaidCA

National Provider Directory

National Provider Directory

Locations

605 W 6th St
San Pedro, CA 90731
Phone (310) 214-8677

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285789487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT NO 2834",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90260",
            "telephone_number": "310-214-8677",
            "fax_number": "310-921-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 W. 6TH STREET",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "90731",
            "telephone_number": "310-241-0330",
            "fax_number": "310-241-0719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA VIDA MULTI-SPECIALTY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHIDI",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-214-8677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "476247-04",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0088194",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.