Provider Demographics
NPI:1316144975
Name:VIELMAN, LUDIM ESTUARDO (PA)
Entity type:Individual
Prefix:MR
First Name:LUDIM
Middle Name:ESTUARDO
Last Name:VIELMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 S. CENTRAL VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263
Mailing Address - Country:US
Mailing Address - Phone:661-459-1913
Mailing Address - Fax:
Practice Address - Street 1:21138 PASO ROBLES HWY
Practice Address - Street 2:
Practice Address - City:LOST HILLS
Practice Address - State:CA
Practice Address - Zip Code:93249
Practice Address - Country:US
Practice Address - Phone:661-979-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19232OtherCALIFORNIA MEDICAL BOARD