Healthcare Provider Details

I. General information

NPI: 1083543771
Provider Name (Legal Business Name): VANESSA GUADALUPE GAMEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 JACARANDA AVE STE 301
HESPERIA CA
92345-4978
US

IV. Provider business mailing address

1500 S HAVEN AVE STE 190
ONTARIO CA
91761-2971
US

V. Phone/Fax

Practice location:
  • Phone: 760-981-1069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: