Doctor Name: | MRS. ENRIQUETA VIVAS |
NPI Number: | 1417070285 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 11547 |
Business Practice Address: | Corp Fondo Del Seguro Del Estado Parque Escorial Carolina, PR - 00987 |
Business Phone Number: | 7877576850 |
Business Fax Number: | |
Mailing Address: | Po Box 503, LUQUILLO |
State: | PR |
Postal Code: | 00773 |
Phone Number: | 7877527856 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 11547 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |