Provider Demographics
NPI:1487999157
Name:HERNANDEZ, VANESSA VARGAS
Entity type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:VARGAS
Last Name:HERNANDEZ
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 1:140 BELLEVIEW DRIVE
Mailing Address - Street 2:3
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94610
Mailing Address - Country:US
Mailing Address - Phone:510-387-2904
Mailing Address - Fax:
Practice Address - Street 1:140 BELLEVIEW DR
Practice Address - Street 2:3
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1756
Practice Address - Country:US
Practice Address - Phone:510-387-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health