Provider Demographics
NPI:1922836014
Name:PENA MORALES, VANESSA N
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:N
Last Name:PENA MORALES
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 1:1000 MALONE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2651
Mailing Address - Country:US
Mailing Address - Phone:408-637-9228
Mailing Address - Fax:
Practice Address - Street 1:411 BOREL AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3525
Practice Address - Country:US
Practice Address - Phone:650-393-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health