Healthcare Provider Details

I. General information

NPI: 1164193587
Provider Name (Legal Business Name): VANESSA ARROYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-6205
US

IV. Provider business mailing address

914 N JACKSON ST
SANTA ANA CA
92703-1724
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-7641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: