Provider Demographics
NPI:1669131744
Name:ZAVALA, VANESSA (RDH)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:209-754-6247
Mailing Address - Fax:209-398-8760
Practice Address - Street 1:12150 NEW YORK RANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9407
Practice Address - Country:US
Practice Address - Phone:209-257-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH30265124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist