Provider Demographics
NPI:1881925949
Name:CUBEROS-OROZCO, VIVIANA CAROLINA (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:CAROLINA
Last Name:CUBEROS-OROZCO
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:11921 SARADRIENNE LN
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5911
Practice Address - Country:US
Practice Address - Phone:239-344-2353
Practice Address - Fax:239-992-4984
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112339207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005810700Medicaid
FLGD420ZMedicare PIN