Provider Demographics
NPI:1275859456
Name:GONNELLA, VANESSA CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:CAROLINA
Last Name:GONNELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:CAROLINA
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:27524 WESTRIDGE CREEK LN STE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5290
Mailing Address - Country:US
Mailing Address - Phone:281-505-1530
Mailing Address - Fax:832-437-7535
Practice Address - Street 1:27524 WESTRIDGE CREEK LN STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5290
Practice Address - Country:US
Practice Address - Phone:281-505-1530
Practice Address - Fax:832-437-7535
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2285208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty