Provider Demographics
NPI:1376955666
Name:VIVA CLINIC P.S.C.
Entity Type:Organization
Organization Name:VIVA CLINIC P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:787-552-7676
Mailing Address - Street 1:201 A CALLE TETUAN
Mailing Address - Street 2:PISO #8 BO VIEJO SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901
Mailing Address - Country:US
Mailing Address - Phone:787-552-7676
Mailing Address - Fax:
Practice Address - Street 1:201 CALLE TETUAN # 8
Practice Address - Street 2:OLD SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1816
Practice Address - Country:US
Practice Address - Phone:787-552-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5393261QM0801X
PR5601261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)