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General NPI Number Information
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NPI Number | 1366696080
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Entity Type | Individual
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Provider Name | LETICIA VENEGAS PT
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Gender | Female
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 338 S DAKOTA AVE
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City | VANDENBERG AFB
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State | CA
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Zip | 93437-6307
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Country | US
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Telephone | 805-606-7595
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Fax |
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Provider Business Mailing Address
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Address Line | 338 S DAKOTA AVE
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City | VANDENBERG AFB
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State | CA
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Zip | 93437-6307
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Country | US
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Telephone | 805-606-7595
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Fax |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 030722
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0307221
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License Number State | NY
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