Provider Demographics
NPI:1992348759
Name:VIEVE
Entity type:Organization
Organization Name:VIEVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-205-4242
Mailing Address - Street 1:3 GROVE ISLE DR APT 908
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4114
Mailing Address - Country:US
Mailing Address - Phone:305-205-4242
Mailing Address - Fax:305-432-4470
Practice Address - Street 1:3661 S MIAMI AVE STE 501
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4200
Practice Address - Country:US
Practice Address - Phone:305-333-8872
Practice Address - Fax:305-432-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053702050Medicaid