Provider Demographics
NPI:1104655679
Name:VIADO, JAMES DARYL SIMEON (RN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES DARYL
Middle Name:SIMEON
Last Name:VIADO
Suffix:
Gender:M
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 ABBOT KINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4839
Mailing Address - Country:US
Mailing Address - Phone:310-945-2734
Mailing Address - Fax:
Practice Address - Street 1:1746 ABBOT KINNEY BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4839
Practice Address - Country:US
Practice Address - Phone:310-945-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health