MEDICARE: DR. RODRIGO VIVAS MD

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	208D00000X	General Practice Physician	ACN 337	FL
2	208D00000X	General Practice Physician	15564	PR

General Provider Information

NPI Number	:	1578598900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODRIGO VIVAS MD

Provider Business Mailing Address
First Line	:	1597 S STATE ROAD 7
Second Line	:	CENTRO MEDICO SAMARITANO
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-4603
Country	:	US
Telephone Number	:	754-205-2376
Fax Number	:	754-205-7523

Provider Business Practice Location Address
First Line	:	1597 SOUTH, STATE ROAD 7
Second Line	:	CENTRO MEDICO SAMARITANO
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068
Country	:	US
Telephone Number	:	754-205-2376
Fax Number	:	754-205-7523

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/18/2015

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