Provider Demographics
NPI:1073323580
Name:PARISE, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PARISE
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 1:36101 BOB HOPE DR STE A
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2001
Mailing Address - Country:US
Mailing Address - Phone:760-321-1315
Mailing Address - Fax:760-321-1094
Practice Address - Street 1:36101 BOB HOPE DR STE A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2001
Practice Address - Country:US
Practice Address - Phone:760-321-1315
Practice Address - Fax:760-321-1094
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty