Provider Demographics
NPI:1902830730
Name:VIVAS, RHONDA REES (PSYD)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:REES
Last Name:VIVAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14707 S DIXIE HWY STE 211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7951
Mailing Address - Country:US
Mailing Address - Phone:305-233-8179
Mailing Address - Fax:305-233-8199
Practice Address - Street 1:14707 S DIXIE HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7948
Practice Address - Country:US
Practice Address - Phone:305-233-8179
Practice Address - Fax:305-233-8199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54570OtherBCBS
FL54570Medicare PIN