Lorena Andrea Vivanco de Martinez, M.D.

Primary specialty

Child Abuse Pediatrics PhysicianTaxonomy code 2080C0008X

License

A73493 Issued in CA

Practice address

3665 Kearny Villa Rd
Ste 501
San Diego, CA 92123-1953

Phone

(858) 966-5803

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lvivancodemartinez101948@direct.llu.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rady Children'S Hospital San Diego

  • Special Hospital
  • San Diego, CA
  • NPI 1508172669
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509062400000",
    "number": "1407927262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5159",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3665 KEARNY VILLA RD",
            "address_2": "STE 501",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231953",
            "telephone_number": "858-966-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVANCO DE MARTINEZ",
        "first_name": "LORENA",
        "middle_name": "ANDREA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2017-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A73493",
            "primary": false
        },
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "CA",
            "license": "A73493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A734930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalimar Vittek, LVN
• Susan Vittek, R.D.
• Dianne Vitug, ASW
• Lemuel Vitug
• Diana Leigh Vitulli, MS.ED
• Shayne Vivanco
• Amanda Theresa Viveiros
• Erika Viveros
• Prisila Cintia Viveros
• Gene Chrissy Rosales Vivo, LMFT

• Child Abuse Pediatrics Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Child Abuse Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.