Healthcare Provider Details

I. General information

NPI: 1477020352
Provider Name (Legal Business Name): VERONICA WEBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE
CERES CA
95307-4562
US

IV. Provider business mailing address

1915 COLLINWOOD DR
HUGHSON CA
95326-9682
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7441
  • Fax: 209-541-2114
Mailing address:
  • Phone: 209-262-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1325201018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: