Healthcare Provider Details

I. General information

NPI: 1487726550
Provider Name (Legal Business Name): ELEANOR C VIERRA RN NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST STE 260
SACRAMENTO CA
95819
US

IV. Provider business mailing address

3400 DATA DRIVE
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-2323
  • Fax: 916-564-3091
Mailing address:
  • Phone: 916-564-3040
  • Fax: 916-564-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number15768
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberNP15768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: