Healthcare Provider Details

I. General information

NPI: 1649276346
Provider Name (Legal Business Name): HECTOR A VERON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 BROCKTON AVE STE 212
RIVERSIDE CA
92506-3815
US

IV. Provider business mailing address

399 E HIGHLAND AVE STE 409
SAN BERNARDINO CA
92404-3866
US

V. Phone/Fax

Practice location:
  • Phone: 951-774-4611
  • Fax: 951-276-3597
Mailing address:
  • Phone: 909-883-3883
  • Fax: 951-276-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: