Healthcare Provider Details

I. General information

NPI: 1972850154
Provider Name (Legal Business Name): CHRISTOPHER VIVAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 7TH TER STE 302
VERO BEACH FL
32960-7330
US

IV. Provider business mailing address

3730 7TH TER STE 302
VERO BEACH FL
32960-7330
US

V. Phone/Fax

Practice location:
  • Phone: 727-736-5317
  • Fax:
Mailing address:
  • Phone: 727-736-5317
  • Fax: 772-539-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2018039387
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number29,093-R
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME146272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: