Provider Demographics
NPI:1174798128
Name:HERRERO, VIVIAN MARIA (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MARIA
Last Name:HERRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:VALVERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:424 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7602
Mailing Address - Country:US
Mailing Address - Phone:727-734-7337
Mailing Address - Fax:727-216-3883
Practice Address - Street 1:424 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7602
Practice Address - Country:US
Practice Address - Phone:727-734-7337
Practice Address - Fax:727-216-3883
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0229208000000X
FLME110840208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004012600Medicaid