Provider Demographics
NPI:1740912328
Name:FLOREZ, VANESSA ELISA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELISA
Last Name:FLOREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CALIFORNIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6472
Mailing Address - Country:US
Mailing Address - Phone:714-683-5876
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6472
Practice Address - Country:US
Practice Address - Phone:714-683-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical