Individual
DR. CARMEN C VIVERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1301 PLANTATION ISLAND DR S, SUITE 402-B, ST AUGUSTINE, FL 32080-3108
(904) 460-0707
(904) 460-0727
Mailing address
1301 PLANTATION ISLAND DR S, SUITE 402-B, ST AUGUSTINE, FL 32080-3108
(904) 460-0707
(904) 460-0727
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
ME0076599
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281237100
—
FL
01
—
44784
BLUE CROSS BLUE SHIELD
FL
01
—
DN9360
RR MEDICARE
FL
Enumeration date
11/21/2006
Last updated
08/19/2011
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