=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033827647
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIAN CONROY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2022
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 BEE CAVES RD STE 440
-----------------------------------------------------
City | WEST LAKE HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-399-0402
-----------------------------------------------------
Fax | 844-460-2062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2920 TELEGRAPH AVE STE 100
-----------------------------------------------------
City | BERKELEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94705-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-329-3727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | PA62237
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA18528
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------