Provider Demographics
NPI:1174672547
Name:NEVES, VANESSA LEONOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LEONOR
Last Name:NEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1595 GRAND AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078
Mailing Address - Country:US
Mailing Address - Phone:760-798-0428
Mailing Address - Fax:760-798-9618
Practice Address - Street 1:1595 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2450
Practice Address - Country:US
Practice Address - Phone:760-798-0428
Practice Address - Fax:760-798-9618
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics