Provider Demographics
NPI:1124744123
Name:VANICEK, CHELSEA (PMHNP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:VANICEK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S HARVARD BLVD APT 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4263
Mailing Address - Country:US
Mailing Address - Phone:224-703-1890
Mailing Address - Fax:
Practice Address - Street 1:1752 S VICTORIA AVE STE 250
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6152
Practice Address - Country:US
Practice Address - Phone:805-650-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022793363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health