Healthcare Provider Details

I. General information

NPI: 1174437719
Provider Name (Legal Business Name): NICOLE VIERRA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 UNION AVE
SAN JOSE CA
95124-5156
US

IV. Provider business mailing address

4850 UNION AVE
SAN JOSE CA
95124-5156
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax: 408-559-3158
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: