Provider Demographics
NPI:1316063522
Name:VENEGAS, EUGENIO (MFT INTERN)
Entity type:Individual
Prefix:MR
First Name:EUGENIO
Middle Name:
Last Name:VENEGAS
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4118
Mailing Address - Country:US
Mailing Address - Phone:323-999-2402
Mailing Address - Fax:
Practice Address - Street 1:5420 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:CA
Practice Address - Zip Code:90042-4118
Practice Address - Country:US
Practice Address - Phone:323-999-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist