Provider Demographics
NPI:1174952246
Name:SISTEMA VIVA INC.
Entity type:Organization
Organization Name:SISTEMA VIVA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BAUZO
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:787-214-0941
Mailing Address - Street 1:RR 4
Mailing Address - Street 2:BOX 3494
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-214-0941
Mailing Address - Fax:
Practice Address - Street 1:941 CALLE EIDER
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2335
Practice Address - Country:US
Practice Address - Phone:787-214-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR997478174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty