Provider Demographics
NPI:1780940643
Name:VIVEIROS, HOLLY MARIA (MT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIA
Last Name:VIVEIROS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HAMAKUA DR STE B
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2849
Mailing Address - Country:US
Mailing Address - Phone:808-261-8931
Mailing Address - Fax:808-261-0301
Practice Address - Street 1:155 HAMAKUA DR STE B
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2849
Practice Address - Country:US
Practice Address - Phone:808-261-8931
Practice Address - Fax:808-261-0301
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist