Provider Demographics
NPI:1740012798
Name:PEREZ-VEGA, VANESSA CITLALLY (LVN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:CITLALLY
Last Name:PEREZ-VEGA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 E PALM CANYON DR APT 5
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-9131
Mailing Address - Country:US
Mailing Address - Phone:760-880-9028
Mailing Address - Fax:
Practice Address - Street 1:1330 N INDIAN CANYON DR STE ABC&G
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-880-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA743973164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse