Provider Demographics
NPI:1366172074
Name:VIERA, MAYELIN
Entity type:Individual
Prefix:
First Name:MAYELIN
Middle Name:
Last Name:VIERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 NORTH DIVISION STREET
Mailing Address - Street 2:ATTN: CREDENTIALS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98433
Mailing Address - Country:US
Mailing Address - Phone:253-966-7081
Mailing Address - Fax:253-966-7848
Practice Address - Street 1:2103 NORTH DIVISION STREET
Practice Address - Street 2:ATTN: CREDENTIALS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-966-7081
Practice Address - Fax:253-966-7848
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1470485651OtherUS ARMY