Provider Demographics
NPI:1821255019
Name:RABER, VANESSA M (LAC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:M
Last Name:RABER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CHEROKEE
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4421
Mailing Address - Country:US
Mailing Address - Phone:805-728-5004
Mailing Address - Fax:
Practice Address - Street 1:22235 SHERMAN WAY STE 100
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1075
Practice Address - Country:US
Practice Address - Phone:805-728-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist