Provider Demographics
NPI:1649276346
Name:VERON, HECTOR A (PA)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:A
Last Name:VERON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:STE 409
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3866
Mailing Address - Country:US
Mailing Address - Phone:909-883-3883
Mailing Address - Fax:951-276-3597
Practice Address - Street 1:6850 BROCKTON AVE
Practice Address - Street 2:STE 212
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3815
Practice Address - Country:US
Practice Address - Phone:951-774-4611
Practice Address - Fax:951-276-3597
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10688363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA106880OtherPPIN
CAOPA106880OtherPPIN