Provider Demographics
NPI:1699464438
Name:VIVEROS, VICTOR HUGO (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:HUGO
Last Name:VIVEROS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 CORTE OLIVAS
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4041
Mailing Address - Country:US
Mailing Address - Phone:805-816-9068
Mailing Address - Fax:
Practice Address - Street 1:300 CARLSBAD VILLAGE DR STE 203
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2990
Practice Address - Country:US
Practice Address - Phone:760-487-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist