Provider Demographics
NPI:1487780516
Name:VIVAR, ZENAIDA L (MD)
Entity type:Individual
Prefix:DR
First Name:ZENAIDA
Middle Name:L
Last Name:VIVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 W COLLEGE DR.
Mailing Address - Street 2:STE 2W
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-361-5110
Mailing Address - Fax:708-361-5305
Practice Address - Street 1:7808 W COLLEGE DR.
Practice Address - Street 2:STE 2W
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-361-5110
Practice Address - Fax:708-361-5305
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL036-057980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13222Medicaid