MEDICARE: VIVIANA PERELLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN31925	FL

General Provider Information

NPI Number	:	1104660471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA PERELLO

Provider Business Mailing Address
First Line	:	330 CATALONIA AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 CATALONIA AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6726
Country	:	US
Telephone Number	:	305-298-5441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/26/2026

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Directions to “ VIVIANA PERELLO ” Practice Location

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