Provider Demographics
NPI:1154554665
Name:OZELLE, VEDA
Entity type:Individual
Prefix:
First Name:VEDA
Middle Name:
Last Name:OZELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VEDA
Other - Middle Name:OZELLE
Other - Last Name:CRITCHLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4245 CAPITOLA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3573
Mailing Address - Country:US
Mailing Address - Phone:831-713-9177
Mailing Address - Fax:
Practice Address - Street 1:4245 CAPITOLA RD STE 205
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3573
Practice Address - Country:US
Practice Address - Phone:831-713-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT51410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherSANTA CRUZ COUNTY HSA-MENTAL HEALTH MEDICARE GROUP PTAN#
CAFHC 70042FOtherSANTA CRUZ COUNTY HSA-MENTAL HEALTH MEDI-CAL PROVIDER #