1225286834 NPI number — MR. EDGAR ALEJANDRO VIVEROS MSW

Table of content: SHAYLEEN TRUJILLO (NPI 1619763638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225286834 NPI number — MR. EDGAR ALEJANDRO VIVEROS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIVEROS
Provider First Name:
EDGAR
Provider Middle Name:
ALEJANDRO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225286834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 POTRERO AVE
Provider Second Line Business Mailing Address:
SUITE 7M-EDCM
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-206-5351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 POTRERO AVE
Provider Second Line Business Practice Location Address:
#7M
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-206-5540
Provider Business Practice Location Address Fax Number:
415-206-8345
Provider Enumeration Date:
09/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: ASW 29101 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1760502298 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ICAN828 . This is a "LA COUNTY DMH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".