Provider Demographics
NPI:1578598900
Name:VIVAS, RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:VIVAS
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 S STATE ROAD 7
Mailing Address - Street 2:CENTRO MEDICO SAMARITANO
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4603
Mailing Address - Country:US
Mailing Address - Phone:754-205-2376
Mailing Address - Fax:754-205-7523
Practice Address - Street 1:1597 SOUTH, STATE ROAD 7
Practice Address - Street 2:CENTRO MEDICO SAMARITANO
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068
Practice Address - Country:US
Practice Address - Phone:754-205-2376
Practice Address - Fax:754-205-7523
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN 337208D00000X
PR15564208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22893Medicare ID - Type Unspecified