Healthcare Provider Details

I. General information

NPI: 1700197449
Provider Name (Legal Business Name): VERONICA PRUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BEACH BLVD STE B
LA HABRA CA
90631-5180
US

IV. Provider business mailing address

PO BOX 335646
NORTH LAS VEGAS NV
89033-5646
US

V. Phone/Fax

Practice location:
  • Phone: 562-267-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number13168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: