Provider Demographics
NPI:1104357078
Name:GONZALEZ, VIVIANNE
Entity Type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:
Last Name:GONZALEZ
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 1:2001 W 68TH ST, SUITE 202
Mailing Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7600 W 20TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1821
Practice Address - Country:US
Practice Address - Phone:786-534-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program