| Doctor Name: | JOSE G VIVALDI |
| NPI Number: | 1053354720 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 13164 |
| Business Practice Address: | Road 111 Km 1.9 Los Patriotas Ave. Lares, PR - 006690379 |
| Business Phone Number: | 7878972727 |
| Business Fax Number: | 7878972725 |
| Mailing Address: | Po Box 379, Los Patriotas Ave. LARES |
| State: | PR |
| Postal Code: | 006690379 |
| Phone Number: | 7878972727 |
| Fax Number: | 7878972725 |
| NPI Enumeration Date: | 06/13/2006 |
| NPI Last Update Date: | 07/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 13164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |