MEDICARE: VANESSA WANG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA22575	CA

General Provider Information

NPI Number	:	1003151259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA WANG PA-C

Provider Business Mailing Address
First Line	:	7830 CLAIREMONT MESA BLVD
Second Line	:	SUITE 203
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1632
Country	:	US
Telephone Number	:	858-300-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	7830 CLAIREMONT MESA BLVD
Second Line	:	SUITE 203
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1632
Country	:	US
Telephone Number	:	858-300-2626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	11/29/2012

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