Healthcare Provider Details

I. General information

NPI: 1942641501
Provider Name (Legal Business Name): VERONICA VACA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 W WILLIAMS ST
LONG BEACH CA
90810-3652
US

IV. Provider business mailing address

2241 W WILLIAMS ST
LONG BEACH CA
90810-3652
US

V. Phone/Fax

Practice location:
  • Phone: 562-388-8180
  • Fax: 562-388-8178
Mailing address:
  • Phone: 562-388-8180
  • Fax: 562-388-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: