Healthcare Provider Details

I. General information

NPI: 1740910066
Provider Name (Legal Business Name): VANESSA WIDLYN JOSEPH NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 E 120TH ST
LOS ANGELES CA
90059-3051
US

IV. Provider business mailing address

1851 PINE AVE APT 17
LONG BEACH CA
90806-5499
US

V. Phone/Fax

Practice location:
  • Phone: 323-563-4800
  • Fax:
Mailing address:
  • Phone: 404-324-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: