Provider Demographics
NPI:1003395062
Name:GARZA, VIVIAN MILAGROS
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MILAGROS
Last Name:GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOSPITAL BUEN SAMARITANO DIRECCION MEDICA
Mailing Address - Street 2:4055 APARTADO
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:18 AVE SEVERIANO CUEVAS KM 141.1 BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14925-I207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14925-IOtherJUNTA LICENCIA MEDICA PUERTO RICO