Provider Demographics
NPI:1033401195
Name:LONGORIA, VERONICA L
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:L
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3106
Mailing Address - Country:US
Mailing Address - Phone:308-635-2231
Mailing Address - Fax:308-635-1271
Practice Address - Street 1:1509 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3106
Practice Address - Country:US
Practice Address - Phone:308-635-2231
Practice Address - Fax:308-635-1271
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE80Medicaid