Individual
MARIE VERONICA DETHOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10399 LEMON AVE STE 101, RANCHO CUCAMONGA, CA 91737-3771
(909) 466-7337
Mailing address
12931 EVERMAY CT, RANCHO CUCAMONGA, CA 91739-9244
(909) 261-2846
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95002884
CA
Other
Enumeration date
01/03/2016
Last updated
01/03/2016
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