Individual
MICHAEL VICIOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PNP
Contact information
Practice address
3835 E 7TH ST, LONG BEACH, CA 90804-5303
(562) 473-4441
(562) 473-4447
Mailing address
3835 E 7TH ST, LONG BEACH, CA 90804-5303
(562) 473-4441
(562) 473-4447
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
22745
CA
Other
Enumeration date
02/18/2013
Last updated
02/10/2020
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