Provider Demographics
NPI:1992299440
Name:SMITH, VANESSA (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:32474 CROWN VALLEY PKWY APT 201
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3317
Mailing Address - Country:US
Mailing Address - Phone:909-240-9228
Mailing Address - Fax:
Practice Address - Street 1:25241 PASEO DE ALICIA STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4623
Practice Address - Country:US
Practice Address - Phone:949-422-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18153171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist