Provider Demographics
NPI:1093110793
Name:PEREZ, VIVIANA
Entity Type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:
Last Name:PEREZ
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 1:538 KOALA DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4210
Mailing Address - Country:US
Mailing Address - Phone:407-300-4200
Mailing Address - Fax:863-496-1324
Practice Address - Street 1:538 KOALA DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4210
Practice Address - Country:US
Practice Address - Phone:407-300-4200
Practice Address - Fax:863-496-1324
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010772500Medicaid