Provider Demographics
NPI:1376912287
Name:KRISTEN VIERREGGER
Entity Type:Organization
Organization Name:KRISTEN VIERREGGER
Other - Org Name:METAMORPHOSIS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:VIERREGGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-484-8000
Mailing Address - Street 1:8081 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3237
Mailing Address - Country:US
Mailing Address - Phone:714-484-8000
Mailing Address - Fax:714-484-8800
Practice Address - Street 1:8081 STANTON AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3237
Practice Address - Country:US
Practice Address - Phone:714-484-8000
Practice Address - Fax:714-484-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112427261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447699582Medicare UPIN