Individual
MISS ALIM VIVANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2641 HIBISCUS WAY, APT 312, BEAVERCREEK, OH 45431-2393
(937) 830-0114
Mailing address
2641 HIBISCUS WAY, APT 312, BEAVERCREEK, OH 45431-2393
(937) 830-0114
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23558185
OH
207R00000X
Internal Medicine Physician
23558185
OH
208D00000X
General Practice Physician
Primary
23558185
OH
Other
Enumeration date
09/22/2011
Last updated
09/22/2011
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