Healthcare Provider Details

I. General information

NPI: 1598098915
Provider Name (Legal Business Name): MS. VANESSA GEESTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11041 VALLEY BLVD
EL MONTE CA
91731-2516
US

IV. Provider business mailing address

2906 SANTA CARLOTTA ST
LA CRESCENTA CA
91214-2022
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-4177
  • Fax: 626-442-4498
Mailing address:
  • Phone: 818-621-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: