Provider Demographics
NPI:1932692142
Name:VIETOR, GERALD EDWARD
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:EDWARD
Last Name:VIETOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W ORANGEBURG AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4042
Mailing Address - Country:US
Mailing Address - Phone:209-501-5648
Mailing Address - Fax:209-526-8681
Practice Address - Street 1:1150 W ORANGEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4042
Practice Address - Country:US
Practice Address - Phone:209-526-9883
Practice Address - Fax:209-526-8681
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3131237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA3131OtherSTATE OF CALIFORNIA