Healthcare Provider Details

I. General information

NPI: 1770400202
Provider Name (Legal Business Name): VET PHOENIX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23697 BAY AVE
MORENO VALLEY CA
92553-3403
US

IV. Provider business mailing address

PO BOX 11373
WHITTIER CA
90603-0373
US

V. Phone/Fax

Practice location:
  • Phone: 562-347-8562
  • Fax:
Mailing address:
  • Phone: 562-347-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MANUEL GOMEZ
Title or Position: CEO
Credential:
Phone: 562-347-8562