Healthcare Provider Details

I. General information

NPI: 1619886595
Provider Name (Legal Business Name): VANESSA GARNICA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GREEN VALLEY RD
FREEDOM CA
95019-3110
US

IV. Provider business mailing address

1597 BELLA VISTA CT
HOLLISTER CA
95023-5871
US

V. Phone/Fax

Practice location:
  • Phone: 831-722-2010
  • Fax:
Mailing address:
  • Phone: 831-207-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95041386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: