Provider Demographics
NPI:1326729682
Name:VIVA DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:VIVA DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAZAGASTI LOURIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-754-8884
Mailing Address - Street 1:601 WESTPARK WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3972
Mailing Address - Country:US
Mailing Address - Phone:817-754-8884
Mailing Address - Fax:
Practice Address - Street 1:601 WESTPARK WAY STE 100
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3972
Practice Address - Country:US
Practice Address - Phone:817-754-8884
Practice Address - Fax:817-754-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty