Individual
MR. EDGARD MARIO VERA TAPIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17207 JASMINE ST, 2, VICTORVILLE, CA 92395
(760) 780-4179
(760) 241-4591
Mailing address
17207 JASMINE ST, 2, VICTORVILLE, CA 92395
(760) 780-4179
(760) 241-4591
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A79177
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A791770
—
CA
05
—
10050B175
—
NV
05
—
1235127515
—
CA
05
—
1871734921
—
CA
Enumeration date
10/11/2005
Last updated
11/20/2014
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