Healthcare Provider Details

I. General information

NPI: 1457538860
Provider Name (Legal Business Name): VERONICA HEREDIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 FOREST AVE SUITE # 7
SAN JOSE CA
95128-4804
US

IV. Provider business mailing address

2016 FOREST AVE SUITE # 7
SAN JOSE CA
95128-4804
US

V. Phone/Fax

Practice location:
  • Phone: 408-289-8410
  • Fax: 408-289-8507
Mailing address:
  • Phone: 408-289-8410
  • Fax: 408-289-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA73219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: