Provider Demographics
NPI:1346336054
Name:VANEGAS, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:VANEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3145
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-8145
Mailing Address - Country:US
Mailing Address - Phone:510-629-2498
Mailing Address - Fax:510-835-2682
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:530
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-629-2498
Practice Address - Fax:510-835-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C504970207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
7372642OtherAETNA
CA00C504970Medicaid
CA00C504971Medicare ID - Type Unspecified
CA00C504970Medicaid