Provider Demographics
NPI:1346250354
Name:VIVONI, SAHIRA (MD)
Entity Type:Individual
Prefix:
First Name:SAHIRA
Middle Name:
Last Name:VIVONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6646
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6646
Mailing Address - Country:US
Mailing Address - Phone:787-746-2065
Mailing Address - Fax:787-746-2085
Practice Address - Street 1:2 CALLE MUNOZ RIVERA
Practice Address - Street 2:PROFESIONAL CENTER BUILDING SUITE 303
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2603
Practice Address - Country:US
Practice Address - Phone:787-746-2065
Practice Address - Fax:787-746-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15203208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI48151Medicare UPIN
PR0023755Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER