Provider Demographics
NPI:1790833291
Name:VIVA PEDIATRICS PA
Entity Type:Organization
Organization Name:VIVA PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-977-9080
Mailing Address - Street 1:7430 BARLITE BLVD SUITE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1366
Mailing Address - Country:US
Mailing Address - Phone:210-977-9080
Mailing Address - Fax:210-977-8480
Practice Address - Street 1:7430 BARLITE BLVD SUITE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1366
Practice Address - Country:US
Practice Address - Phone:210-977-9080
Practice Address - Fax:210-977-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD1659OtherLICESNSE