Provider Demographics
NPI:1164556452
Name:SLOBODNIK, VERONICA ROJAS (PA-C)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ROJAS
Last Name:SLOBODNIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:TOOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3730
Mailing Address - Country:US
Mailing Address - Phone:559-791-7000
Mailing Address - Fax:559-782-1418
Practice Address - Street 1:1107 WEST POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5839
Practice Address - Country:US
Practice Address - Phone:559-781-7242
Practice Address - Fax:559-793-3542
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13081363A00000X
IL85001867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ10425Medicare UPIN
ILK14224Medicare PIN