Healthcare Provider Details

I. General information

NPI: 1295157469
Provider Name (Legal Business Name): DAVID VIVERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 PORTER DR
PALO ALTO CA
94304-1212
US

IV. Provider business mailing address

3150 PORTER DR
PALO ALTO CA
94304-1212
US

V. Phone/Fax

Practice location:
  • Phone: 415-496-9602
  • Fax:
Mailing address:
  • Phone: 415-496-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: