Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD046761L | PA |
NPI | 1063519114 |
---|---|
Provider Name | Carlos A Vivas |
First Address | Pittsburgh, PA 15212-4769 |
Second Address | Pittsburgh, PA 15212-4769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001288346 | (05) | PA |
10938218 | CAQH (01) | |
F27066 | (02) | PA |