Healthcare Provider Details

I. General information

NPI: 1336269216
Provider Name (Legal Business Name): CLAUDIA T. VIAMONTES M.D., PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N. NEW BALLAS SUITE 332
ST. LOUIS MO
63141
US

IV. Provider business mailing address

2120 MADISON AVE SUITE 404
GRANITE CITY IL
62040
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-0542
  • Fax: 618-876-7596
Mailing address:
  • Phone: 618-876-7515
  • Fax: 618-876-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6P47
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberR6P47
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR6P47
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: