MEDICARE: VIVIANA MALENO APRN

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	363L00000X	Nurse Practitioner	11044188	FL

General Provider Information

NPI Number	:	1487501789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA MALENO APRN

Provider Business Mailing Address
First Line	:	12709 NW 11TH CT
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-3116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10418 W ATLANTIC BLVD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-5605
Country	:	US
Telephone Number	:	954-258-8710
Fax Number	:

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

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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