Provider Demographics
NPI:1942582911
Name:CABREZA, VIVIENNE LOPEZ (MD)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:LOPEZ
Last Name:CABREZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 METROPOLITAN OVAL APT 1D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6524
Mailing Address - Country:US
Mailing Address - Phone:347-820-0273
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3044
Practice Address - Fax:718-334-5759
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No208000000XAllopathic & Osteopathic PhysiciansPediatrics