Provider Demographics
NPI:1356015614
Name:PARRA, VANESSA (CRDH)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PARRA
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 SW 164TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5106
Mailing Address - Country:US
Mailing Address - Phone:305-389-4186
Mailing Address - Fax:
Practice Address - Street 1:14050 SW 84TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4440
Practice Address - Country:US
Practice Address - Phone:305-389-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26150124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist