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General NPI Number Information
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NPI Number | 1700696226
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Entity Type | Individual
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Provider Name | VERONICA GARDE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | NEW AGE GASTROENTEROLOGY 2195 CLUB CENTER DR. STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-654-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 13973 BLOSSOM WAY
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City | EASTVALE
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State | CA
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Zip | 92880-6409
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Country | US
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Telephone | 520-213-6249
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95027251
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License Number State | CA
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