Healthcare Provider Details

I. General information

NPI: 1366083610
Provider Name (Legal Business Name): VANESSA M FULINARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47825 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

42740 TIMOTHY CIR
PALM DESERT CA
92260-2051
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8455
  • Fax:
Mailing address:
  • Phone: 760-485-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number756791
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: