Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN18606 | FL |
NPI | 1073747333 |
---|---|
Provider Name | Dr. Vivian Manjarres |
First Address | Miramar, FL 33029-5553 |
Second Address | Miami Lakes, FL 33016-1581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 14/05/2009 |