Provider Demographics
NPI:1174841522
Name:AVERY, VERONICA EVELYN (LAC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:EVELYN
Last Name:AVERY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:EVELYN
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:939 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2580
Mailing Address - Country:US
Mailing Address - Phone:805-400-9723
Mailing Address - Fax:
Practice Address - Street 1:939 OAK ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2580
Practice Address - Country:US
Practice Address - Phone:805-400-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13614171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist