| Doctor Name: | DR. ISIDRO VIVANCO |
| NPI Number: | 1003860461 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME0022225 |
| Business Practice Address: | 440 W 49th St Hialeah, FL - 330123603 |
| Business Phone Number: | 3058285000 |
| Business Fax Number: | |
| Mailing Address: | 3191 Coral Way, CORAL GABLES |
| State: | FL |
| Postal Code: | 331453213 |
| Phone Number: | 3054616060 |
| Fax Number: | |
| NPI Enumeration Date: | 05/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0022225 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |