Healthcare Provider Details

I. General information

NPI: 1629191127
Provider Name (Legal Business Name): WILLIAM R VIVAS DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW 27TH AVE SUITE# 408A
MIAMI FL
33135-2961
US

IV. Provider business mailing address

330 SW 27TH AVE SUITE# 408A
MIAMI FL
33135-2961
US

V. Phone/Fax

Practice location:
  • Phone: 305-542-5153
  • Fax: 305-642-5213
Mailing address:
  • Phone: 305-542-5153
  • Fax: 305-642-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO1733
License Number StateFL

VIII. Authorized Official

Name: WILLIAM R VIVAS
Title or Position: PRESIDENT
Credential: DPM
Phone: 305-642-5153