Provider Demographics
NPI:1942367685
Name:VIVEIROS, THERESA A
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:VIVEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:ADIB HANNA
Other - Last Name:ST MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:450 ROCK STREET
Mailing Address - Street 2:UNIT 19
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-646-9422
Mailing Address - Fax:
Practice Address - Street 1:1563 NORTH MAIN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:508-679-8590
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program