Healthcare Provider Details

I. General information

NPI: 1396439691
Provider Name (Legal Business Name): VIVIAN CONCEPCION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5568 GIBRALTAR DR
PLEASANTON CA
94588-8544
US

IV. Provider business mailing address

5568 GIBRALTAR DR
PLEASANTON CA
94588-8544
US

V. Phone/Fax

Practice location:
  • Phone: 925-534-6500
  • Fax:
Mailing address:
  • Phone: 925-534-6500
  • Fax: 833-690-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA210992
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT228163
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: