Basic Information
| Provider Information | |||||||||
| NPI: | 1265159131 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIVA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7001 | ||||||||
| Address2: | |||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006947001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876087368 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSPITAL WILMA N. VAZQUEZ | ||||||||
| Address2: | CARR. #2 KM 39.5 OFICNA 201 | ||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878581580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2022 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRIZARRY NIEVES | ||||||||
| AuthorizedOfficialFirstName: | EDUARDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7876087368 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.