Healthcare Provider Details

I. General information

NPI: 1891297560
Provider Name (Legal Business Name): ANGEL M VERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 INLAND EMPIRE BLVD
ONTARIO CA
91764-4898
US

IV. Provider business mailing address

12142 CENTRAL AVE PMB 285
CHINO CA
91710-2420
US

V. Phone/Fax

Practice location:
  • Phone: 909-458-1518
  • Fax:
Mailing address:
  • Phone: 909-244-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW115602
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04388
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: