Provider Demographics
NPI:1679114235
Name:MACIEL, VERONICA LIZBETH
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LIZBETH
Last Name:MACIEL
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 1:513 LORRAINE PL
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5709
Mailing Address - Country:US
Mailing Address - Phone:626-756-2789
Mailing Address - Fax:
Practice Address - Street 1:513 LORRAINE PL
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5709
Practice Address - Country:US
Practice Address - Phone:626-756-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty