Provider Demographics
NPI:1467152058
Name:OLIVARES, VANESSA (MS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:OLIVARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15760 VENTURA BLVD STE 1060
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3065
Mailing Address - Country:US
Mailing Address - Phone:818-788-2388
Mailing Address - Fax:
Practice Address - Street 1:15760 VENTURA BLVD STE 1060
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3065
Practice Address - Country:US
Practice Address - Phone:818-788-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46-0508169106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst