Provider Demographics
NPI:1306600143
Name:YANEZ, VANESSA CINNAMON (RDH)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:CINNAMON
Last Name:YANEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 THOMAS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4034
Mailing Address - Country:US
Mailing Address - Phone:808-631-2083
Mailing Address - Fax:
Practice Address - Street 1:969 THOMAS AVE APT 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4034
Practice Address - Country:US
Practice Address - Phone:808-631-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27882124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist