Healthcare Provider Details

I. General information

NPI: 1346006426
Provider Name (Legal Business Name): STAR RENEE VANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR STE 628
LOS ANGELES CA
90008-3606
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR STE 628
LOS ANGELES CA
90008-3606
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-9094
  • Fax: 661-265-1101
Mailing address:
  • Phone: 661-940-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: