Healthcare Provider Details

I. General information

NPI: 1376252213
Provider Name (Legal Business Name): MARIA VIANEY VIGUERIAS TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W 190TH ST
GARDENA CA
90248-4319
US

IV. Provider business mailing address

1515 W 190TH ST
GARDENA CA
90248-4319
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-9115
  • Fax:
Mailing address:
  • Phone: 310-329-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: