Provider Demographics
NPI:1164738720
Name:ISTIBAN, VIVIAN CHARLY (AP)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:CHARLY
Last Name:ISTIBAN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7550 S RED RD
Mailing Address - Street 2:#116
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5343
Mailing Address - Country:US
Mailing Address - Phone:305-669-6699
Mailing Address - Fax:305-669-6699
Practice Address - Street 1:7550 S RED RD
Practice Address - Street 2:#116
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5343
Practice Address - Country:US
Practice Address - Phone:305-669-6699
Practice Address - Fax:305-669-6699
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist