Provider Demographics
NPI:1871381590
Name:CARREON, VERONICA BAUTISTA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:BAUTISTA
Last Name:CARREON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 LA COSTA CT
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-5531
Mailing Address - Country:US
Mailing Address - Phone:909-997-0494
Mailing Address - Fax:
Practice Address - Street 1:15497 W SAND ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2910
Practice Address - Country:US
Practice Address - Phone:442-327-9311
Practice Address - Fax:442-327-9315
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker