Healthcare Provider Details

I. General information

NPI: 1639321508
Provider Name (Legal Business Name): VERONICA ROBERTOS MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 QUILL DR
DOWNEY CA
90242
US

IV. Provider business mailing address

7285 QUILL DR
DOWNEY CA
90242-2098
US

V. Phone/Fax

Practice location:
  • Phone: 562-940-6077
  • Fax:
Mailing address:
  • Phone: 562-940-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number85535
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: