Provider Demographics
NPI:1437181682
Name:VIERRA, VIRGINIA (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:VIERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-965-3600
Mailing Address - Fax:801-965-3526
Practice Address - Street 1:5063 COTTONWOOD ST
Practice Address - Street 2:SUITE 160
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6766
Practice Address - Country:US
Practice Address - Phone:801-507-1850
Practice Address - Fax:801-507-1875
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51152961205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1912097189Medicaid
UT1912097189Medicaid
UT000061531Medicare PIN