Provider Demographics
NPI:1710932967
Name:FERRARIO, VANESSA D (PAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:D
Last Name:FERRARIO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:DORENE
Other - Last Name:BEEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2488 N CALIFORNIA ST
Mailing Address - Street 2:ALPINE ORTHOPAEDIC MEDICAL GROUP INC
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5508
Mailing Address - Country:US
Mailing Address - Phone:209-948-3333
Mailing Address - Fax:209-948-2665
Practice Address - Street 1:2488 N CALIFORNIA ST
Practice Address - Street 2:ALPINE ORTHOPAEDIC MEDICAL GROUP INC
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5508
Practice Address - Country:US
Practice Address - Phone:209-948-3333
Practice Address - Fax:209-948-2665
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00252712OtherRR MCR
CGP159090OtherCGP
CAZZZ71793ZMedicaid
0368640001OtherDMERC
195690700OtherUSDL
195690700OtherUSDL