Alim Vivanco

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

23558185 Issued in OH

Practice address

2641 Hibiscus Way
Apt 312
Beavercreek, OH 45431-2393

Phone

(937) 830-0114

NPI assigned

Sep 22, 2011

Last updated

Sep 22, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1881977171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 HIBISCUS WAY",
            "address_2": "APT 312",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312393",
            "telephone_number": "937-830-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 HIBISCUS WAY",
            "address_2": "APT 312",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312393",
            "telephone_number": "937-830-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVANCO",
        "first_name": "ALIM",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "23558185",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "23558185",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "23558185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Viola
• Vision Service Corporation (Eye Mart)
• Vision Value (Stanton Optical)
• Visualeyes, Inc. (Beavercreek Vision Centrer)
• Ronald Anthony Vitullo, D.D.S.
• Greggory Scott Volk, D.O.
• Kevin Volt, M.D.
• Hans William Vonniederhausern
• Peter Waisala, DPT
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2124)

• General Practice Physician in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• General Practice Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.