Healthcare Provider Details

I. General information

NPI: 1861924243
Provider Name (Legal Business Name): VERONICA CARMONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-6300
  • Fax:
Mailing address:
  • Phone: 626-486-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1082366
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1082366
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1082366
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1082366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: