Healthcare Provider Details

I. General information

NPI: 1487566717
Provider Name (Legal Business Name): VANESSA MACIAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 400
LA JOLLA CA
92037-1212
US

IV. Provider business mailing address

7084 FRIARS RD APT 206
SAN DIEGO CA
92108-5109
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-8666
  • Fax:
Mailing address:
  • Phone: 210-845-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95444885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: