Healthcare Provider Details

I. General information

NPI: 1881063493
Provider Name (Legal Business Name): VIVIANA ANDREA MARTINEZ GALVIS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 115
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-4515
  • Fax:
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: