1255834743 NPI number — VERONICA ARMENTA BA, BS, SLPA

Table of content: VERONICA ARMENTA BA, BS, SLPA (NPI 1255834743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255834743 NPI number — VERONICA ARMENTA BA, BS, SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMENTA
Provider First Name:
VERONICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, BS, SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255834743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 MONTEBELLO DR APT D203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILROY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95020-4844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILROY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95020-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-847-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TBT17071010T . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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