Provider Demographics
NPI:1407555667
Name:RODARTE, VANESSA ANDREA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANDREA
Last Name:RODARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6686 WHITEWELL RD
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9154
Mailing Address - Country:US
Mailing Address - Phone:818-480-0158
Mailing Address - Fax:
Practice Address - Street 1:6686 WHITEWELL RD
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9154
Practice Address - Country:US
Practice Address - Phone:818-480-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician