1487661898 NPI number — DR. VIVIANNE M GARCIA FERNANDEZ O.D.

Table of content: DR. VIVIANNE M GARCIA FERNANDEZ O.D. (NPI 1487661898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487661898 NPI number — DR. VIVIANNE M GARCIA FERNANDEZ O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA FERNANDEZ
Provider First Name:
VIVIANNE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487661898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 C MUNOZ RIVERA ESQ CELIS AGUILERA
Provider Second Line Business Mailing Address:
C2
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-903-0140
Provider Business Mailing Address Fax Number:
787-744-2860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE MUNOZ RIVERA 9 C2
Provider Second Line Business Practice Location Address:
ESQ CELIS AGUILERA
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-9888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-903-1120
Provider Business Practice Location Address Fax Number:
787-963-0335
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  607 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0058537 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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