Provider Demographics
NPI:1639356777
Name:VENEGAS, MARICAR
Entity Type:Individual
Prefix:
First Name:MARICAR
Middle Name:
Last Name:VENEGAS
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 1:10020 AUTUMN SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3312
Mailing Address - Country:US
Mailing Address - Phone:916-647-3711
Mailing Address - Fax:916-647-3711
Practice Address - Street 1:10020 AUTUMN SAGE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3312
Practice Address - Country:US
Practice Address - Phone:916-647-3711
Practice Address - Fax:916-647-3711
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0800538343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)