Healthcare Provider Details

I. General information

NPI: 1841017514
Provider Name (Legal Business Name): VIVIANA HERNANDEZ-FERRER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DABNER ST
SAN LEANDRO CA
94577-1474
US

IV. Provider business mailing address

122 DABNER ST
SAN LEANDRO CA
94577-1474
US

V. Phone/Fax

Practice location:
  • Phone: 510-812-3551
  • Fax:
Mailing address:
  • Phone: 510-812-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number36014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: