Provider Demographics
NPI:1942445440
Name:VERA, DAVID R SR (CO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:VERA
Suffix:SR
Gender:M
Credentials:CO
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Mailing Address - Street 1:1300 W LODI AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3000
Mailing Address - Country:US
Mailing Address - Phone:209-625-8450
Mailing Address - Fax:209-224-8416
Practice Address - Street 1:1300 W LODI AVE
Practice Address - Street 2:SUITE H
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3000
Practice Address - Country:US
Practice Address - Phone:209-625-8450
Practice Address - Fax:209-224-8416
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2012-11-02
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Provider Licenses
StateLicense IDTaxonomies
CACO003590222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist