Healthcare Provider Details

I. General information

NPI: 1982980355
Provider Name (Legal Business Name): MRS. VERONICA DENISE CLANTON-HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 S SAN PEDRO ST
LOS ANGELES CA
90003-3030
US

IV. Provider business mailing address

15622 S TARRANT AVE
COMPTON CA
90220-3229
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: