Healthcare Provider Details

I. General information

NPI: 1720580715
Provider Name (Legal Business Name): VIVIAN ISEL CLAVERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HOLLYWOOD BLVD STE 300
PEMBROKE PINES FL
33024-7982
US

IV. Provider business mailing address

260 E 65TH ST
HIALEAH FL
33013-1051
US

V. Phone/Fax

Practice location:
  • Phone: 786-517-6999
  • Fax:
Mailing address:
  • Phone: 786-908-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9292911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9292911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: