Provider Demographics
NPI:1467494104
Name:VIESTI, CARL R JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:R
Last Name:VIESTI
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:3720 SUNSET LN
Mailing Address - Street 2:STE D
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6124
Mailing Address - Country:US
Mailing Address - Phone:925-778-1444
Mailing Address - Fax:925-778-9014
Practice Address - Street 1:3720 SUNSET LN
Practice Address - Street 2:STE D
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6124
Practice Address - Country:US
Practice Address - Phone:925-778-1444
Practice Address - Fax:925-778-9014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY6785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL67850Medicare ID - Type Unspecified