Provider Demographics
NPI:1336316025
Name:MONTENEGRO-JAUREGUI, VERONICA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MONTENEGRO-JAUREGUI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 HEIL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:751 W LEGION RD STE 204
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7755
Practice Address - Country:US
Practice Address - Phone:760-351-3296
Practice Address - Fax:760-351-3142
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19686OtherPHYSICIAN ASSISTANT