Healthcare Provider Details

I. General information

NPI: 1750227336
Provider Name (Legal Business Name): GABRIEL VIVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

1142 NW 130TH AVE
PEMBROKE PINES FL
33028-2732
US

V. Phone/Fax

Practice location:
  • Phone: 754-422-2589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH200005126
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: