Provider Demographics
NPI:1669470167
Name:VIERRA, ELIZABETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
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 1:13186 SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2458
Mailing Address - Country:US
Mailing Address - Phone:858-451-3311
Mailing Address - Fax:858-451-1142
Practice Address - Street 1:15525 POMERADO RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2435
Practice Address - Country:US
Practice Address - Phone:858-451-3311
Practice Address - Fax:858-451-1142
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A648650Medicaid
WA64865AMedicare ID - Type Unspecified
CAH13042Medicare UPIN