Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME128624 | FL |
NPI | 1033551163 |
---|---|
Provider Name | Dr. Alejandra Carolina Vivas |
First Address | Maitland, FL 32751-7172 |
Second Address | Miramar, FL 33029-5593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2013 |
Last Update Date | 11/11/2016 |