1295062800 NPI number — VERONICA V VIVEROS LPC

Table of content: VERONICA V VIVEROS LPC (NPI 1295062800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295062800 NPI number — VERONICA V VIVEROS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIVEROS
Provider First Name:
VERONICA
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

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:
1295062800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 S STAPLES ST
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78413-2952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-774-9595
Provider Business Mailing Address Fax Number:
361-991-4843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4639 CORONA DR STE 37
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-442-4024
Provider Business Practice Location Address Fax Number:
361-853-7877
Provider Enumeration Date:
11/03/2009

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: 101YP2500X , with the licence number:  58915 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209410405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com