Provider Demographics
NPI:1568634723
Name:MANSILLA, VANESSA L (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:MANSILLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LIZZET
Other - Last Name:MANSILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:6517 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3003
Mailing Address - Country:US
Mailing Address - Phone:323-773-8295
Mailing Address - Fax:323-773-0656
Practice Address - Street 1:6517 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-3003
Practice Address - Country:US
Practice Address - Phone:323-773-8295
Practice Address - Fax:323-773-0656
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP17679OtherCA LICENSE
CANP17679OtherSTATE OF CA RN BOARD