Healthcare Provider Details

I. General information

NPI: 1124940820
Provider Name (Legal Business Name): VIVIANA AIJA FERRER MARTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARQUE DE CANDELERO 171 PARQUE DE CANDELERO 171
HUMACAO PR
00791
US

IV. Provider business mailing address

PARQUE DE CANDELERO 171 PARQUE DE CANDELERO 171
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-649-2596
  • Fax:
Mailing address:
  • Phone: 787-649-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15057
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: