Provider Demographics
NPI:1609380955
Name:GARAY, VERONICA (PMHNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:GARAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 PARK FRONT WALK
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3943
Mailing Address - Country:US
Mailing Address - Phone:323-807-2743
Mailing Address - Fax:
Practice Address - Street 1:479 PARK FRONT WALK
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3943
Practice Address - Country:US
Practice Address - Phone:323-807-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008074363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health