Healthcare Provider Details

I. General information

NPI: 1164092862
Provider Name (Legal Business Name): VERONICA D WANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA D DIONISIO NP

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N GRAND AVE
GLENDORA CA
91741-2434
US

IV. Provider business mailing address

4003 QUARTZITE LN
SAN BERNARDINO CA
92407-0468
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-0385
  • Fax:
Mailing address:
  • Phone: 909-908-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number95049360
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: