Provider Demographics
NPI:1164092862
Name:WANG, VERONICA D (NP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:D
Last Name:WANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:D
Other - Last Name:DIONISIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4003 QUARTZITE LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-0468
Mailing Address - Country:US
Mailing Address - Phone:909-908-2658
Mailing Address - Fax:
Practice Address - Street 1:130 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2434
Practice Address - Country:US
Practice Address - Phone:626-963-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95049360163WX0003X
CA95020173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient