Vivian Fan
Individual provider Active NPI Family Nurse Practitioner · San Marino, CA
NPI 1972323558 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1972323558
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95030461 (CA)
- Practice address
- 1437 San Marino Ave
San Marino, CA 91108-2027 - Phone
- (626) 793-7922
- NPI assigned
- Oct 16, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95030461 | CA | Yes |
Addresses
Primary practice location
1437 San Marino Ave
San Marino, CA 91108-2027
Mailing address
1132 S 3Rd St
Alhambra, CA 91801-4723
Phone (626) 492-2880
Other providers in San Marino, CA
- Equality, an Independent Practice Association, Inc., a Medical Group
- Elizabeth Esquivel
- Ronald Philip Estrada
- Camille J Fagenson
- Michael Fan
- Chien Fang
- Fary Yassamy, DDS, Inc
- Fit Home Health Inc
- Alfonso Fonzie Flores
- Fluid Laboratories
All providers in San Marino, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.