Provider Demographics
NPI:1679920912
Name:VIELMA, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VIELMA
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 1:837 MEDINA ST
Mailing Address - Street 2:1-A
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4065
Mailing Address - Country:US
Mailing Address - Phone:830-776-3839
Mailing Address - Fax:830-773-9119
Practice Address - Street 1:330 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4515
Practice Address - Country:US
Practice Address - Phone:830-776-3839
Practice Address - Fax:830-773-9119
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2016009970251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health