Healthcare Provider Details

I. General information

NPI: 1447873989
Provider Name (Legal Business Name): VERONICA LEONOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 7TH AVE
SANTA CRUZ CA
95062-4668
US

IV. Provider business mailing address

200 7TH AVE
SANTA CRUZ CA
95062-4668
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-1060
  • Fax: 831-462-4970
Mailing address:
  • Phone: 831-462-1060
  • Fax: 831-462-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1362920919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: