Healthcare Provider Details

I. General information

NPI: 1104660471
Provider Name (Legal Business Name): VIVIANA PERELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CATALONIA AVE
CORAL GABLES FL
33134-6726
US

IV. Provider business mailing address

330 CATALONIA AVE
CORAL GABLES FL
33134-6726
US

V. Phone/Fax

Practice location:
  • Phone: 305-298-5441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31925
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: