Basic Information
Provider Information
NPI: 1417569070
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAENZ
FirstName: VERONICA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1330 E COOLEY DR
Address2:  
City: COLTON
State: CA
PostalCode: 923243905
CountryCode: US
TelephoneNumber: 9095803705
FaxNumber:  
Practice Location
Address1: 1330 E COOLEY DR
Address2:  
City: COLTON
State: CA
PostalCode: 923243905
CountryCode: US
TelephoneNumber: 9095803705
FaxNumber: 9095803747
Other Information
ProviderEnumerationDate: 08/17/2020
LastUpdateDate: 09/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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