Provider Demographics
NPI:1851365134
Name:VIERRA, DAVID JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:VIERRA
Suffix:JR
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 1:5333 HOLLISTER AVE
Mailing Address - Street 2:# 130
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2341
Mailing Address - Country:US
Mailing Address - Phone:805-967-6351
Mailing Address - Fax:
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:# 130
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2341
Practice Address - Country:US
Practice Address - Phone:805-967-6351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73116207L00000X
MA78794207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG73116EMedicare PIN
CAWG73116AMedicare ID - Type UnspecifiedMEDICARE #
CAWG73116CMedicare PIN
CAF90722Medicare UPIN
CAWG73116DMedicare PIN