Provider Demographics
NPI:1578681052
Name:BARROGA, VERONICA (OTR)
Entity type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:
Last Name:BARROGA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:BARROGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:2180 W GRANT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2180 W GRANT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7343
Practice Address - Country:US
Practice Address - Phone:925-463-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4638225X00000X
CA1031100046225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4638OtherOTR
CA1031100046OtherCHT
CA4638OtherOTR
CAZZZ05239ZOtherIND. PTAN