Provider Demographics
NPI:1457538860
Name:HEREDIA, VERONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 FOREST AVE
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4804
Mailing Address - Country:US
Mailing Address - Phone:408-289-8410
Mailing Address - Fax:408-289-8507
Practice Address - Street 1:2016 FOREST AVE
Practice Address - Street 2:SUITE # 7
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4804
Practice Address - Country:US
Practice Address - Phone:408-289-8410
Practice Address - Fax:408-289-8507
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73219208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732190Medicaid