Provider Demographics
NPI:1710449525
Name:TABARES, VANESSA
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:
Last Name:TABARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E ELMWOOD AVE APT P
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2641
Mailing Address - Country:US
Mailing Address - Phone:424-299-9177
Mailing Address - Fax:
Practice Address - Street 1:215 E ELMWOOD AVE APT P
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2641
Practice Address - Country:US
Practice Address - Phone:424-299-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator