Provider Demographics
NPI:1649804972
Name:HALL, VANESSA MARTINEZ (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARTINEZ
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:MARTINEZ
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:VANESSA HALL FNP
Mailing Address - Street 1:6126 HARVEY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3126
Mailing Address - Country:US
Mailing Address - Phone:562-668-2962
Mailing Address - Fax:
Practice Address - Street 1:11900 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2866
Practice Address - Country:US
Practice Address - Phone:323-756-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95076133OtherRN LICENCE
CA95014022OtherNURSE PRACTITIONER