Provider Demographics
NPI:1205592565
Name:CAGNOLA FLORES, VIVIANA SOPHIA
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:SOPHIA
Last Name:CAGNOLA FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11953 40TH ST N
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9104
Mailing Address - Country:US
Mailing Address - Phone:561-631-5706
Mailing Address - Fax:
Practice Address - Street 1:11953 40TH ST N
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-9104
Practice Address - Country:US
Practice Address - Phone:561-631-5706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist