Basic Information
| Provider Information | |||||||||
| NPI: | 1629323118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIERRA | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | PHILLIPP | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5111 N 10TH ST | ||||||||
| Address2: | #112 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785042835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566319739 | ||||||||
| FaxNumber: | 9566316717 | ||||||||
| Practice Location | |||||||||
| Address1: | 5111 N 10TH ST | ||||||||
| Address2: | #112 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785042835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566319739 | ||||||||
| FaxNumber: | 9566316717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P9274 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 338892805 | 05 | TX | MEDICAID |