| NPI | 1619300654 |
|---|---|
| Former Name | VIVIAN RAEL RIVERA ROMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111563) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 3559) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2020-01-27 |