Provider Demographics
NPI:1659483154
Name:VIERRA, BRIAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:VIERRA
Suffix:
Gender:M
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 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-7560
Mailing Address - Fax:209-725-7561
Practice Address - Street 1:378 W OLIVE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3182
Practice Address - Country:US
Practice Address - Phone:209-725-7560
Practice Address - Fax:209-725-7561
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G709010Medicaid
CAF09946Medicare UPIN
CA00G709010Medicaid
CA00G709012Medicare PIN