Provider Demographics
NPI:1366001042
Name:VECEREK, NATALIA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:MARIE
Last Name:VECEREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:626-457-6601
Mailing Address - Fax:323-865-5621
Practice Address - Street 1:1441 EASTLAKE AVENUE
Practice Address - Street 2:EZRALOW TOWER, SUITE 5301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-865-0233
Practice Address - Fax:323-865-5621
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA181266207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology