1487726550 NPI number — MS. ELEANOR C VIERRA RN NPC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487726550 NPI number — MS. ELEANOR C VIERRA RN NPC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

VIERRA

Provider First Name:

ELEANOR

Provider Middle Name:

C

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

RN NPC

Provider Gender Code:

F

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:

1487726550

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/05/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3400 DATA DRIVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RANCHO CORDOVA

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

95670-7956

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

916-564-3040

Provider Business Mailing Address Fax Number:

916-564-3065

Provider First Line Business Practice Location Address:

3941 J ST

Provider Second Line Business Practice Location Address:

STE 260

Provider Business Practice Location Address City Name:

SACRAMENTO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95819

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

916-736-2323

Provider Business Practice Location Address Fax Number:

916-564-3091

Provider Enumeration Date:

11/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  NP15768 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LA2100X , with the licence number: 15768 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: ZZZ47673Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: GR0068230 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: GR0068233 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00301682 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: ZZZ47675Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: GR0068231 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: GR0068232 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: ZZZ47676Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: GR0068235 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: GR006823B , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: ZZZ62306Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: RN378972 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".