MEDICARE: MS. RHONDA REES VIVAS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY5916	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54570	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1902830730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA REES VIVAS PSYD

Provider Business Mailing Address
First Line	:	14707 S DIXIE HWY STE 211
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-7951
Country	:	US
Telephone Number	:	305-233-8179
Fax Number	:	305-233-8199

Provider Business Practice Location Address
First Line	:	14707 S DIXIE HWY
Second Line	:	SUITE 211
City	:	MIAMI
State	:	FL
Zip	:	33176-7948
Country	:	US
Telephone Number	:	305-233-8179
Fax Number	:	305-233-8199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	02/14/2014

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