Provider Demographics
NPI:1942434089
Name:VERA-MAHAFFEY, ADRIENNE ROSE (IDMT)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:ROSE
Last Name:VERA-MAHAFFEY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:ROSE
Other - Last Name:MAHAFFEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDMT
Mailing Address - Street 1:3267 PALOMINO CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7227
Mailing Address - Country:US
Mailing Address - Phone:707-423-5395
Mailing Address - Fax:707-423-5426
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-5395
Practice Address - Fax:707-423-5426
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians