Provider Demographics
NPI:1316792419
Name:VIVANCO MENOSCAL, RICARDO ALEJANDRO (MD)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:ALEJANDRO
Last Name:VIVANCO MENOSCAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S. LIMESTONE
Mailing Address - Street 2:ROOM J401
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-218-5038
Mailing Address - Fax:859-257-0754
Practice Address - Street 1:740 S. LIMESTONE
Practice Address - Street 2:ROOM J401
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-218-5038
Practice Address - Fax:859-257-0754
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program