Provider Demographics
NPI:1487661898
Name:GARCIA FERNANDEZ, VIVIANNE M (OD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANNE
Middle Name:M
Last Name:GARCIA FERNANDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 C MUNOZ RIVERA ESQ CELIS AGUILERA
Mailing Address - Street 2:C2
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-903-0140
Mailing Address - Fax:787-744-2860
Practice Address - Street 1:CALLE MUNOZ RIVERA 9 C2
Practice Address - Street 2:ESQ CELIS AGUILERA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9888
Practice Address - Country:US
Practice Address - Phone:787-903-1120
Practice Address - Fax:787-963-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058537Medicaid