Healthcare Provider Details

I. General information

NPI: 1699406983
Provider Name (Legal Business Name): NILVIA EDITH VIAMONTE PEREZ RDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 06/18/2022
Certification Date: 06/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 W MAUNA LOA LN
PHOENIX AZ
85053-4655
US

IV. Provider business mailing address

3720 W MAUNA LOA LN
PHOENIX AZ
85053-4655
US

V. Phone/Fax

Practice location:
  • Phone: 315-640-5905
  • Fax:
Mailing address:
  • Phone: 315-640-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number261834
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number261834
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number261834
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number261834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: