Provider Demographics
NPI:1689144693
Name:ADETULA, VERONICA ADE
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ADE
Last Name:ADETULA
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:PO BOX 181714
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-1714
Mailing Address - Country:US
Mailing Address - Phone:682-553-3100
Mailing Address - Fax:972-293-8901
Practice Address - Street 1:330 COOPER ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2628
Practice Address - Country:US
Practice Address - Phone:682-553-3100
Practice Address - Fax:972-293-8901
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307651261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care