Provider Demographics
NPI:1619949005
Name:CHAVARRIA, VICENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:
Last Name:CHAVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 N KENDALL DR STE 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1469
Mailing Address - Country:US
Mailing Address - Phone:305-670-7006
Mailing Address - Fax:305-670-7806
Practice Address - Street 1:10700 N KENDALL DR STE 304
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1469
Practice Address - Country:US
Practice Address - Phone:305-670-7006
Practice Address - Fax:305-670-7806
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60493207K00000X
FL60493207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375946601Medicaid
FL25753Medicare ID - Type Unspecified
FL375946601Medicaid