Healthcare Provider Details

I. General information

NPI: 1861863193
Provider Name (Legal Business Name): ADRIANA VERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 E BRIER DRIVE SUITE 200
SAN BERNARDINO CA
92415
US

IV. Provider business mailing address

658 E BRIER DRIVE SUITE 200
SAN BERNARDINO CA
92415-3248
US

V. Phone/Fax

Practice location:
  • Phone: 909-501-0700
  • Fax: 909-381-2330
Mailing address:
  • Phone: 909-501-0700
  • Fax: 909-381-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: