Healthcare Provider Details

I. General information

NPI: 1548970593
Provider Name (Legal Business Name): DONALD ANTHONY VIEIRA JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3355 WYOMING CT
STOCKTON CA
95212-3433
US

V. Phone/Fax

Practice location:
  • Phone: 650-852-3274
  • Fax: 650-496-2501
Mailing address:
  • Phone: 209-479-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95021513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: