Individual provider · NPI-1

Aida Ason Vivanco

Psychologist, Health · Doral, FL

NPI number1366972663
StatusActive
Last updated in NPPESAug 12, 2024

Details

NPI
1366972663
Entity type
Individual (NPI-1)
Name
Aida Ason Vivanco
Sex
Female
Sole proprietor
Yes
Enumeration date
Jun 19, 2017
Certification date
Aug 12, 2024
Last updated
Aug 12, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103TH0004X Psychologist, HealthIMH7588FLYes

Practice location

8175 Nw 12th St Ste 119
Doral, FL 33126-1828

Phone 786-362-5981

Mailing address

8175 Nw 12th St Ste 119
Doral, FL 33126-1828

Phone 786-362-5981

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