Provider Demographics
NPI:1225281819
Name:OBREGON, VANESSA L (PA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:OBREGON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 ENDEAVORDRIVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1970
Mailing Address - Country:US
Mailing Address - Phone:956-726-4929
Mailing Address - Fax:956-724-6242
Practice Address - Street 1:2337 ENDEAVOR DRIVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1970
Practice Address - Country:US
Practice Address - Phone:956-726-4929
Practice Address - Fax:956-724-6242
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L17856Medicare PIN
TX613536/GROUP PTANMedicare PIN