Provider Demographics
NPI:1659820165
Name:HERNANDEZ, VANESSA ZAYONARA (BA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ZAYONARA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HAGEN OAKES CT
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2372
Mailing Address - Country:US
Mailing Address - Phone:760-685-1564
Mailing Address - Fax:
Practice Address - Street 1:1002 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4605
Practice Address - Country:US
Practice Address - Phone:760-741-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator