Provider Demographics
NPI:1811215080
Name:CAGUIOA, VANESSA OBEDOZA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:OBEDOZA
Last Name:CAGUIOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:FAJARDO
Other - Last Name:OBEDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:507 TELEGRAPH CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6436
Mailing Address - Country:US
Mailing Address - Phone:619-421-2988
Mailing Address - Fax:619-421-8979
Practice Address - Street 1:507 TELEGRAPH CANYON RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6436
Practice Address - Country:US
Practice Address - Phone:619-421-2988
Practice Address - Fax:619-421-8979
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 62631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist