Basic Information
| Provider Information | |||||||||
| NPI: | 1164556452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLOBODNIK | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | ROJAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TOOMBS | ||||||||
| OtherFirstName: | VERONICA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 314 NORTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597917000 | ||||||||
| FaxNumber: | 5597821418 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 WEST POPLAR AVE | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932575839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597817242 | ||||||||
| FaxNumber: | 5597933542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 04/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA13081 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 85001867 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.