Provider Demographics
NPI:1073790424
Name:VEGI, SHARADA (PHD)
Entity Type:Individual
Prefix:
First Name:SHARADA
Middle Name:
Last Name:VEGI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8352
Mailing Address - Country:US
Mailing Address - Phone:909-967-0216
Mailing Address - Fax:951-279-0892
Practice Address - Street 1:3463 RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8352
Practice Address - Country:US
Practice Address - Phone:909-967-0216
Practice Address - Fax:951-279-0892
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist