Provider Demographics
NPI:1063552784
Name:HENRY, VERNON L (HHP)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:HENRY
Suffix:
Gender:M
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 3RD AVE
Mailing Address - Street 2:301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4933
Mailing Address - Country:US
Mailing Address - Phone:619-204-5069
Mailing Address - Fax:
Practice Address - Street 1:2560 1ST AVE
Practice Address - Street 2:STE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6534
Practice Address - Country:US
Practice Address - Phone:619-204-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist