Vivanco De Martinez, Lorena Andrea

Vivanco De Martinez, Lorena Andrea is an individual health care provider with primary practice located at 3665 Kearny Villa Rd Ste 501, San Diego CA 92123-1953. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Child Abuse Pediatrics. Allopathic & Osteopathic Physicians / Child Abuse Pediatrics is her primary health care specialty. Vivanco De Martinez, Lorena Andrea can be contacted via phone (858) 966-5803.

Contact Information

Primary practice address
3665 Kearny Villa Rd Ste 501 San Diego CA 92123-1953
Phone: (858) 966-5803
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A73493 California
Allopathic & Osteopathic Physicians / Child Abuse Pediatrics 2080C0008X A73493 California

Profile Details

NPI number 1407927262
LBN Legal business name Vivanco De Martinez, Lorena Andrea
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2006
Last updated Oct 27th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407927262 NPPES
California MEDICAID 00A734930

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