Healthcare Provider Details

I. General information

NPI: 1740855840
Provider Name (Legal Business Name): VERONICA HLATKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PCH HWY
HERMOSA BEACH CA
90254-3213
US

IV. Provider business mailing address

1721 CARLSON LN
REDONDO BEACH CA
90278-4712
US

V. Phone/Fax

Practice location:
  • Phone: 424-218-6083
  • Fax:
Mailing address:
  • Phone: 303-668-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT116882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: