Healthcare Provider Details

I. General information

NPI: 1861828063
Provider Name (Legal Business Name): AVIVA HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 DUCK AVE
KEY WEST FL
33040-4427
US

IV. Provider business mailing address

353 CYPRESS PKWY
KISSIMMEE FL
34759-3326
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-9771
  • Fax: 305-295-0059
Mailing address:
  • Phone: 813-434-1273
  • Fax: 813-434-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number4716284079
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EDUARDO GARRIDO
Title or Position: CEO
Credential: PA
Phone: 407-343-0542