Provider Demographics
NPI:1396945770
Name:NEAL, VANESSA LAQUINTE (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LAQUINTE
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:LAQUINTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3553 CAMINO MIRA COSTA STE D
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3512
Mailing Address - Country:US
Mailing Address - Phone:949-200-7737
Mailing Address - Fax:949-336-1949
Practice Address - Street 1:3553 CAMINO MIRA COSTA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3512
Practice Address - Country:US
Practice Address - Phone:949-200-7737
Practice Address - Fax:949-336-1949
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116016592174400000X
CAA104294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty