Provider Demographics
NPI:1306059290
Name:VIVAS, IRIS M (MD)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:M
Last Name:VIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N. 29TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020
Mailing Address - Country:US
Mailing Address - Phone:954-276-3400
Mailing Address - Fax:954-965-6444
Practice Address - Street 1:3400 N. 29TH AVENUE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:954-276-3400
Practice Address - Fax:954-965-6444
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4309662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD430966Medicare UPIN