Healthcare Provider Details

I. General information

NPI: 1841532413
Provider Name (Legal Business Name): VERA LEE REEVES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERA LEE MEDLAND RN

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 10/11/2018
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: 626-398-6300
  • Fax: 626-398-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number561031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: