Basic Information
| Provider Information | |||||||||
| NPI: | 1003006784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPHRAIM | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | YVETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MONTES | ||||||||
| OtherFirstName: | VERONICA | ||||||||
| OtherMiddleName: | YVETTE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1202 MORENA BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193983261 | ||||||||
| FaxNumber: | 6192752023 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 MORENA BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193983261 | ||||||||
| FaxNumber: | 6192752023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 47778 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.