Individual
LORENA ANDREA VIVANCO DE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3665 KEARNY VILLA RD, STE 501, SAN DIEGO, CA 92123-1953
(858) 966-5803
Mailing address
3020 CHILDRENS WAY # MC5159, SAN DIEGO, CA 92123-4223
(858) 966-5803
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A73493
CA
2080C0008X
Child Abuse Pediatrics Physician
Primary
A73493
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A734930
—
CA
Enumeration date
11/13/2006
Last updated
10/27/2017
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