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General NPI Number Information
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NPI Number | 1235127515
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Entity Type | Individual
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Provider Name | EDGARD MARIO VERA TAPIA MD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 17207 JASMINE ST 2
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 760-780-4179
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Fax | 760-241-4591
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Provider Business Mailing Address
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Address Line | 17207 JASMINE ST 2
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 760-780-4179
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Fax | 760-241-4591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A79177
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License Number State | CA
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