Jennifer L Vivanco, RPT

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT20306 Issued in CA

Practice address

11239 Tampa Ave Ste 205
Porter Ranch, CA 91326-3782

Phone

(818) 831-0484

Fax

(818) 832-9389

NPI assigned

Dec 18, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Physical Therapist in Private Practice

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spine and Body WellnessGroup PAC ID 4587170360, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spine and Body Wellness

  • Physical Medicine & Rehabilitation Physician
  • Woodland Hills, CA
  • NPI 1982481172
  Care Compare group
• Healthy Hearts Medical Group Inc

  • Family Medicine Physician
  • Reseda, CA
  • NPI 1295906402
  NPD (past)
• Healthy Hearts Medical Group Inc

  • Family Medicine Physician
  • Panorama City, CA
  • NPI 1417189341
  NPD (past)
• Managed Care Rehab., Inc.

  • Specialist
  • Northridge, CA
  • NPI 1881749323
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1982767596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11239 TAMPA AVE STE 205",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913263782",
            "telephone_number": "818-831-0484",
            "fax_number": "818-832-9389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11239 TAMPA AVE STE 205",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913263782",
            "telephone_number": "818-831-0484",
            "fax_number": "818-832-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVANCO",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT20306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0203060",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juliette NK Vaspra, MS, RDN
• Abel Villalvazo
• Natalia Villatoro
• Paul Vincze, LMT
• Kayane Kouyoumjian Violante, PHARMD
• Walden Behavioral Group
• Walmart Inc.
• We Care Urgent Care
• We Care Urgent Care PC
• James Robert Weagley, M.D.

• Specialist in Porter Ranch, CA
• Providers in Porter Ranch, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.