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NPI Code Detail

MEDICARE: VIVIAN MAC NP

MEDICARE: VIVIAN MAC NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner23840CA

General Provider Information

NPI Number : 1477982114
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN MAC NP
Provider Business Mailing Address
First Line : 19201 BEAR VALLEY RD
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92308-2702
Country : US
Telephone Number : 760-240-8347
Fax Number :
Provider Business Practice Location Address
First Line : 19201 BEAR VALLEY RD
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92308-2702
Country : US
Telephone Number : 760-240-8347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2013
Last Update Date : 11/30/2021

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Directions to “ VIVIAN MAC NP” Practice Location

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