LORENA ANDREA VIVANCO DE MARTINEZ (NPI# 1407927262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407927262 |
| Entity Type | Individual |
| Full Name | LORENA ANDREA VIVANCO DE MARTINEZ |
| Credential | M.D. |
| Practice Address |
3665 Kearny Villa Rd Ste 501 San Diego CA 92123-1953 |
| Mailing Address |
3020 Childrens Way # Mc5159 San Diego CA 92123-4223 |
| Practice Telephone | 8589665803 |
| Mailing Telephone | 8589665803 |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2017-10-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | A73493 | CA | Allopathic & Osteopathic Physicians |
| Y | 2080C0008X |
Pediatrics Specialization: Child Abuse Pediatrics |
A73493 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A734930 | 05 |
| Street Address |
3665 KEARNY VILLA RD STE 501 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92123-1953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962508481 | Rady's Children's Hospital Outpatient Psychiatry San Diego | Marriage & Family Therapist | 3665 Kearny Villa Rd, 165, San Diego, CA 92123-1953 | 2006-09-15 |
| 1851952907 | Allison Rawls | Student in an Organized Health Care Education/Training Program | 3665 Kearny Villa Rd, San Diego, CA 92123-1953 | 2019-06-27 |
| 1578044012 | Neilson Chan | Student in an Organized Health Care Education/Training Program | 3665 Kearny Villa Rd, San Diego, CA 92123-1953 | 2018-08-23 |
| 1063907038 | Page Naomi Beukelman | Audiologist | 3665 Kearny Villa Rd, San Diego, CA 92123-1953 | 2018-06-22 |
| 1982119293 | Yesenia C Mejia | Psychologist | 3665 Kearny Villa Rd, San Diego, CA 92123-1953 | 2017-12-08 |
| 1104335835 | Stephanie Keffer | Speech-Language Pathologist | 3665 Kearny Villa Rd, San Diego, CA 92123-1953 | 2017-09-26 |
| 1740728179 | Natasha Proa | Case Manager/Care Coordinator | 3665 Kearny Villa Rd, Suite 165, San Diego, CA 92123-1953 | 2017-02-06 |
| 1194268425 | Kimberlee Ramirez | Speech-Language Pathologist | 3665 Kearny Villa Rd, Suite 300, San Diego, CA 92123-1953 | 2016-11-17 |
| 1073989380 | Brielle Williams | Speech-Language Pathologist | 3665 Kearny Villa Rd, Suite 300, San Diego, CA 92123 | 2015-08-20 |
| 1871969436 | Tara Jobin | Audiologist | 3665 Kearny Villa Rd, San Diego, CA 92123-1953 | 2015-08-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087326 | Corina Lozano Manzo | Registered Nurse | 7436 Mission Center Road, San Diego, CA 92123 | 2020-09-10 |
| 1831703537 | Shannon Leigh Doolittle | Audiologist | 3020 Children's Way Mc5010, San Diego, CA 92123 | 2020-09-01 |
| 1861014359 | Ha Thanh Truong | Pharmacist | Rezcare, 3821 Calle Fortunada, San Diego, CA 92123 | 2020-05-07 |
| 1023667136 | Brittany Meyer | Physical Therapist | 3020 Children's Waymc5068, San Diego, CA 92123 | 2019-09-11 |
| 1598313272 | Ryan Edward Shaw | Marriage & Family Therapist | 8910 Clairmont Mesa Blvd, San Diego, CA 92123 | 2019-08-27 |
| 1528611910 | Tanisha C Fulcher | Marriage & Family Therapist | 8825 Aero Dr., Ste 315, San Diago, CA 92123 | 2019-07-24 |
| 1245795665 | Robin James Pekin | Marriage & Family Therapist | 4450 Kearny Villa Rd, #116, San Diego, CA 92123 | 2019-02-11 |
| 1174093728 | Karen Vences | Counselor | 8755 Aero Dr Suite 230, San Diego, CA 92123 | 2018-11-27 |
| 1255808465 | Natasha Herrera | Counselor | 2801 Meadow Lark Dr, San Diego, San Diego, CA 92123 | 2018-10-25 |
| 1407321987 | Maneka Elikewela | Behavior Technician | 3934 Murphy Canyon Rd, Ste B202, San Diego, CA 92123 | 2018-10-10 |
| Find all providers in zip 92123 | ||||
| Taxonomy Code | 2080C0008X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Child Abuse Pediatrics |
| A Child Abuse Pediatrician serves as a resource to children, families and communities by accurately diagnosing abuse; consulting with community agencies on child safety; providing expertise in courts of law; treating consequences of abuse and neglect; directing child abuse and neglect prevention programs and participating on multidisciplinary teams investigating; and managing child abuse cases. |
| Notes: Source: American Board of Medical Specialties, 2009 [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942243456 | John Stirling | Pediatrics | 1629 Granada Ave, San Diego, CA 92102-1435 | 2006-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780889691 | Catherine A Deridder | Pediatrics | 1000 W Carson St # 437, Harbor-ucla Medical Center, Torrance, CA 90502-2004 | 2007-06-19 |
| 1831544113 | Astrid Heger | Pediatrics | 2010 Zonal Ave, Los Angeles, CA 90033-1026 | 2016-04-25 |
| 1689975955 | James Edward Crawford | Pediatrics | 747 52nd St, Oakland, CA 94609-1809 | 2010-11-03 |
| 1679895544 | Van Nguyen Greco | Pediatrics | 101 The City Dr S, Bldg 56, Suite 600, Orange, CA 92868-3201 | 2010-02-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.