Provider Demographics
NPI:1336778141
Name:ARIAS, VANESSA (SLP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ARIAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3612
Mailing Address - Country:US
Mailing Address - Phone:831-461-5588
Mailing Address - Fax:
Practice Address - Street 1:3003 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3612
Practice Address - Country:US
Practice Address - Phone:831-461-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist