Healthcare Provider Details

I. General information

NPI: 1871405126
Provider Name (Legal Business Name): VIVAGENE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 SW 132ND ST STE 207A
MIAMI FL
33186-7207
US

IV. Provider business mailing address

12855 SW 132ND ST STE 207A
MIAMI FL
33186-7207
US

V. Phone/Fax

Practice location:
  • Phone: 786-658-7935
  • Fax: 786-221-3203
Mailing address:
  • Phone: 786-658-7935
  • Fax: 786-221-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE GONZALEZ
Title or Position: OWNER
Credential:
Phone: 786-658-7935