Healthcare Provider Details

I. General information

NPI: 1790914158
Provider Name (Legal Business Name): FELIPE ALEJANDRO VIVAS OROZCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD KENT HOSPITAL
WARWICK RI
02886-2759
US

IV. Provider business mailing address

11112 PATRIOT WAY
WEST GREENWICH RI
02817-6008
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7010
  • Fax:
Mailing address:
  • Phone: 203-706-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14015
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: