Healthcare Provider Details

I. General information

NPI: 1669470167
Provider Name (Legal Business Name): ELIZABETH E VIERRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD SUITE A-2
POWAY CA
92064-2435
US

IV. Provider business mailing address

13186 SUNDANCE AVE
SAN DIEGO CA
92129-2458
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-3311
  • Fax: 858-451-1142
Mailing address:
  • Phone: 858-451-3311
  • Fax: 858-451-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA64865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: