Healthcare Provider Details

I. General information

NPI: 1144779166
Provider Name (Legal Business Name): VERONICA DOLORES KAUFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA DOLORES BOCANEGRA LCSW

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E. HIGHLAND AVENUE MEDICAL STAFF OFFICE
PATTON CA
92369
US

IV. Provider business mailing address

3102 E. HIGHLAND AVENUE MEDICAL STAFF OFFICE
PATTON CA
92369
US

V. Phone/Fax

Practice location:
  • Phone: 909-425-7000
  • Fax:
Mailing address:
  • Phone: 909-425-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW21214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: