Provider Demographics
NPI:1093718652
Name:VIVONI, VICTOR E (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:E
Last Name:VIVONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 140310
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0310
Mailing Address - Country:US
Mailing Address - Phone:787-878-3397
Mailing Address - Fax:787-880-4104
Practice Address - Street 1:CONDOMINIO PROFESIONAL ARECIBO MEDICAL CENTER
Practice Address - Street 2:SUITE 203 CARR #2 KM 80.1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614-0310
Practice Address - Country:US
Practice Address - Phone:787-878-3397
Practice Address - Fax:787-880-4104
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0095199Medicare ID - Type Unspecified