Healthcare Provider Details

I. General information

NPI: 1871076174
Provider Name (Legal Business Name): VIVIENA BERNICE SHIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

7678 PEACH BLOSSOM DR
CUPERTINO CA
95014-5249
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-1111
  • Fax:
Mailing address:
  • Phone: 408-930-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: