Healthcare Provider Details

I. General information

NPI: 1366114423
Provider Name (Legal Business Name): VERONIKA ELYSSA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 S HARBOR BLVD STE 200
SANTA ANA CA
92704-7936
US

IV. Provider business mailing address

23740 SANDHURST LN
HARBOR CITY CA
90710-1419
US

V. Phone/Fax

Practice location:
  • Phone: 657-356-6490
  • Fax:
Mailing address:
  • Phone: 951-208-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number20763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: