Healthcare Provider Details

I. General information

NPI: 1992763825
Provider Name (Legal Business Name): MARGARITA VERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 THIRD ST. 166
FT IRWIN CA
92310
US

IV. Provider business mailing address

147 W MAIN ST
BARSTOW CA
92311-2220
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3114
  • Fax:
Mailing address:
  • Phone: 760-255-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number639057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: