Provider Demographics
NPI:1528357449
Name:BATES, VANESSA LINDSAY (MED)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LINDSAY
Last Name:BATES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 VAN NUYS BLVD
Mailing Address - Street 2:6TH FLOOR,
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-901-4930
Mailing Address - Fax:
Practice Address - Street 1:6842 VAN NUYS BLVD
Practice Address - Street 2:6TH FLOOR,
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-901-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator