Provider Demographics
NPI:1417773672
Name:BELL, VERONICA ALTAGRACIA
Entity type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:ALTAGRACIA
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 TOUCHTON RD E APT 1031
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4467
Mailing Address - Country:US
Mailing Address - Phone:860-264-5482
Mailing Address - Fax:
Practice Address - Street 1:9889 GATE PKWY N STE 205
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9229
Practice Address - Country:US
Practice Address - Phone:860-264-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty