Provider Demographics
NPI:1699590935
Name:TUCKER, VANESSA LEILANI (LAC)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LEILANI
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:LEILANI
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1203B N SIGNAL ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-1831
Mailing Address - Country:US
Mailing Address - Phone:805-826-8594
Mailing Address - Fax:
Practice Address - Street 1:1203B N SIGNAL ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-1831
Practice Address - Country:US
Practice Address - Phone:805-826-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC835171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist