Provider Demographics
NPI:1396117784
Name:VERA, DAVID (CAMTC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:CAMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 ORANGE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3072
Mailing Address - Country:US
Mailing Address - Phone:562-444-5098
Mailing Address - Fax:
Practice Address - Street 1:1704 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1812
Practice Address - Country:US
Practice Address - Phone:818-970-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31027173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31027OtherCAMTC