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NPI Code Detail

MEDICARE: MICHAEL VICIOSO PNP

MEDICARE: MICHAEL VICIOSO PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner22745CA

General Provider Information

NPI Number : 1932449642
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL VICIOSO PNP
Provider Business Mailing Address
First Line : 3835 E 7TH ST
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-5303
Country : US
Telephone Number : 562-473-4441
Fax Number : 562-473-4447
Provider Business Practice Location Address
First Line : 3835 E 7TH ST
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-5303
Country : US
Telephone Number : 562-473-4441
Fax Number : 562-473-4447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2013
Last Update Date : 02/10/2020

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