Provider Demographics
NPI:1629613898
Name:VERA, PRISCILLA NICOLE
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:NICOLE
Last Name:VERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4504
Mailing Address - Country:US
Mailing Address - Phone:661-852-5674
Mailing Address - Fax:661-852-5694
Practice Address - Street 1:1300 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4504
Practice Address - Country:US
Practice Address - Phone:661-852-5674
Practice Address - Fax:661-852-5694
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator