Provider Demographics
NPI:1659728285
Name:VERNON, MARIE A
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:VERNON
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:P.O. BOX 2572
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-4448
Mailing Address - Country:US
Mailing Address - Phone:951-898-5733
Mailing Address - Fax:
Practice Address - Street 1:6860 BROCKTON AVE STE 9
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3816
Practice Address - Country:US
Practice Address - Phone:844-657-4748
Practice Address - Fax:844-746-7646
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator