Provider Demographics
NPI:1689278517
Name:GARCIA, VANESSA ROSE (CNM)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROSE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2824
Mailing Address - Country:US
Mailing Address - Phone:510-759-3194
Mailing Address - Fax:
Practice Address - Street 1:1665 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3312
Practice Address - Country:US
Practice Address - Phone:530-332-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015550363LW0102X
CA236135176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health