Healthcare Provider Details

I. General information

NPI: 1437181682
Provider Name (Legal Business Name): VIRGINIA VIERRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5063 COTTONWOOD ST SUITE 160
MURRAY UT
84107-6766
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1850
  • Fax: 801-507-1875
Mailing address:
  • Phone: 801-965-3600
  • Fax: 801-965-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51152961205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: