Healthcare Provider Details

I. General information

NPI: 1063917458
Provider Name (Legal Business Name): MARIA VERONICA HEARD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 05/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E PRINCETON ST
ONTARIO CA
91764
US

IV. Provider business mailing address

740 E PRINCETON ST
ONTARIO CA
91764-2408
US

V. Phone/Fax

Practice location:
  • Phone: 909-230-2657
  • Fax:
Mailing address:
  • Phone: 909-230-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: