Provider Demographics
NPI:1225289630
Name:VIERA, CHARLES (TEM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:VIERA
Suffix:
Gender:M
Credentials:TEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 LOS ROBLES STREET
Mailing Address - Street 2:URB LAS CUMBRES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-790-4342
Mailing Address - Fax:
Practice Address - Street 1:439 LOS ROBLES STREET
Practice Address - Street 2:URB LAS CUMBRES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-790-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-131341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance