Basic Information
| Provider Information | |||||||||
| NPI: | 1134662166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABBAD | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14506 JEREMIE ST APT D | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917064366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263544243 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2610 INDUSTRY WAY | ||||||||
| Address2: | A | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106318004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2016 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT37931 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.