Provider Demographics
NPI:1679230338
Name:VINCI, VANESSA L (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:VINCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 GRAND AVE APT 345
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4840
Mailing Address - Country:US
Mailing Address - Phone:201-452-1842
Mailing Address - Fax:
Practice Address - Street 1:183 CALLE MAGDALENA STE 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3793
Practice Address - Country:US
Practice Address - Phone:866-957-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner