MEDICARE: HECTOR A VERON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10688	CA
2	363AS0400X	Surgical Physician Assistant	PA10688	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPA106880	OTHER	CA	PPIN

General Provider Information

NPI Number	:	1649276346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR A VERON PA

Provider Business Mailing Address
First Line	:	399 E HIGHLAND AVE
Second Line	:	STE 409
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3866
Country	:	US
Telephone Number	:	909-883-3883
Fax Number	:	951-276-3597

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE
Second Line	:	STE 212
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3815
Country	:	US
Telephone Number	:	951-774-4611
Fax Number	:	951-276-3597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	01/21/2011

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