Healthcare Provider Details

I. General information

NPI: 1811233778
Provider Name (Legal Business Name): VANESSA GANTES PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KING AVE
CORCORAN CA
93212-9611
US

IV. Provider business mailing address

5669 N FRESNO ST APT 134
FRESNO CA
93710-8307
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-8800
  • Fax:
Mailing address:
  • Phone: 831-998-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: