Provider Demographics
NPI:1811193717
Name:VANDENBERG, GUY J (MSW, RN)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:J
Last Name:VANDENBERG
Suffix:
Gender:M
Credentials:MSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 POTRERO AVE
Mailing Address - Street 2:BUILDING 80, WARD 86
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2859
Mailing Address - Country:US
Mailing Address - Phone:415-206-2482
Mailing Address - Fax:415-502-4777
Practice Address - Street 1:995 POTRERO AVE
Practice Address - Street 2:BUILDING 80, WARD 86
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-206-2482
Practice Address - Fax:415-502-4777
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500719163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development