Healthcare Provider Details

I. General information

NPI: 1043778574
Provider Name (Legal Business Name): VANESA V CONTRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21101 DALE EVANS PKWY
APPLE VALLEY CA
92307-9356
US

IV. Provider business mailing address

755 E GILBERT ST
SAN BERNARDINO CA
92404-5403
US

V. Phone/Fax

Practice location:
  • Phone: 760-961-6768
  • Fax:
Mailing address:
  • Phone: 909-387-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number136374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: