Healthcare Provider Details

I. General information

NPI: 1215583729
Provider Name (Legal Business Name): FRANCES MARIE VESECKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W HOSPITALITY LN STE 208
SAN BERNARDINO CA
92408-3211
US

IV. Provider business mailing address

325 W HOSPITALITY LN STE 208
SAN BERNARDINO CA
92408-3211
US

V. Phone/Fax

Practice location:
  • Phone: 909-963-5377
  • Fax:
Mailing address:
  • Phone: 909-963-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: