Provider Demographics
NPI:1033409875
Name:HERNANDEZ, VERONICA LUISA
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:LUISA
Last Name:HERNANDEZ
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 1:22 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4767
Mailing Address - Country:US
Mailing Address - Phone:909-623-3505
Mailing Address - Fax:
Practice Address - Street 1:22 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:PHILLIPS RANCH
Practice Address - State:CA
Practice Address - Zip Code:91766-4767
Practice Address - Country:US
Practice Address - Phone:909-623-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37282126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant