Provider Demographics
NPI:1255098596
Name:VAN DER LINDEN, VANESSA FIALLOS (MS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:FIALLOS
Last Name:VAN DER LINDEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W ORION AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7066
Mailing Address - Country:US
Mailing Address - Phone:951-314-4114
Mailing Address - Fax:
Practice Address - Street 1:2701 W ORION AVE APT 2
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7066
Practice Address - Country:US
Practice Address - Phone:951-314-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist