Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A151628 | CA |
NPI | 1265810964 |
---|---|
Provider Name | Sergio Viera |
First Address | Gardena, CA 90248-4505 |
Second Address | Gardena, CA 90248-4505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2015 |
Last Update Date | 30/11/2021 |