Provider Demographics
NPI:1336937713
Name:JEFFERS, VIRIDIANA (MD)
Entity type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:
Last Name:JEFFERS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:VIRIDIANA
Other - Middle Name:
Other - Last Name:GODINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2414 CROSBY ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4513
Mailing Address - Country:US
Mailing Address - Phone:773-574-8029
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD SPC 3030
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4735
Practice Address - Country:US
Practice Address - Phone:808-485-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-9001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine