Individual
DR. VIVIAN VIRELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5245 US HIGHWAY 98 N, LAKELAND, FL 33809-0516
(863) 644-3585
(863) 644-3171
Mailing address
5425 S FLORIDA AVE, LAKELAND, FL 33813-2523
(863) 644-3585
(863) 644-3171
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
15253
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15253
LIC.
PR
Enumeration date
10/11/2005
Last updated
11/09/2020
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