Provider Demographics
NPI:1780154880
Name:NAVA, VANESSA MONIC
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MONIC
Last Name:NAVA
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 1:100 PARK PLAZA BLVD APT 1104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6830
Mailing Address - Country:US
Mailing Address - Phone:619-608-3420
Mailing Address - Fax:
Practice Address - Street 1:10680 TREENA ST STE 170
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2443
Practice Address - Country:US
Practice Address - Phone:858-432-4749
Practice Address - Fax:858-432-4750
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician