Active NPI
Tyda Viveros
- Licensed Psychiatric Technician
- Stockton, CA
National Provider Identifier
1063946002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 37052
- Practice address
- 1111 N El Dorado St
Stockton, CA 95202-1305 - Phone
- (209) 938-0228
- Fax
- (209) 938-0281
- NPI assigned
- Apr 17, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 37052 | CA | Primary |
Addresses
Primary practice location
1111 N El Dorado St
Stockton, CA 95202-1305
Mailing address
1111 N. Eldorado Street
Stockton, CA 95202
Phone (209) 938-0228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37052 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medmark Treatment Centers - Stockton, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Methadone Clinic
- Stockton, CA
- NPI 1851453500
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492387200000",
"number": "1063946002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 N. ELDORADO STREET",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95202",
"telephone_number": "209-938-0228",
"fax_number": "209-938-0281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 N EL DORADO ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021305",
"telephone_number": "209-938-0228",
"fax_number": "209-938-0281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIVEROS",
"first_name": "TYDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-17",
"last_updated": "2017-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "37052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.