Provider Demographics
NPI:1518500404
Name:VIADAS, GERARDO (RDHAP)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:VIADAS
Suffix:
Gender:M
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 W FERNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7104
Mailing Address - Country:US
Mailing Address - Phone:323-727-2078
Mailing Address - Fax:
Practice Address - Street 1:258 W FERNFIELD DR
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7104
Practice Address - Country:US
Practice Address - Phone:323-727-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP734124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist