Provider Demographics
NPI:1720460819
Name:VIVAS, ALYSSA PABELLE DIPALAC (DO)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA PABELLE
Middle Name:DIPALAC
Last Name:VIVAS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:21212 E OCOTILLO RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9667
Mailing Address - Country:US
Mailing Address - Phone:602-755-0800
Mailing Address - Fax:480-571-7973
Practice Address - Street 1:21212 E OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9667
Practice Address - Country:US
Practice Address - Phone:602-755-0800
Practice Address - Fax:480-571-7973
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2022-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZR2590207Q00000X
AZ007363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine