Healthcare Provider Details

I. General information

NPI: 1427593250
Provider Name (Legal Business Name): JOSE VIANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COLUMBIA RD
DORCHESTER MA
02125-2424
US

IV. Provider business mailing address

415 COLUMBIA RD
DORCHESTER MA
02125-2424
US

V. Phone/Fax

Practice location:
  • Phone: 617-287-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2305154
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: