Healthcare Provider Details

I. General information

NPI: 1508194101
Provider Name (Legal Business Name): VIVIAN VIVAS COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2538
US

IV. Provider business mailing address

C/DIEGO VELAZQUEZ D.42 URB. EL CONQUISTADOR
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-5559
  • Fax:
Mailing address:
  • Phone: 787-923-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1798
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: