Healthcare Provider Details

I. General information

NPI: 1629057237
Provider Name (Legal Business Name): VANESSA MARIA KALIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 MEDICAL CENTER RD SUITE 222
MISSION VIEJO CA
92691-6410
US

IV. Provider business mailing address

333 CORPORATE DR STE 102
LADERA RANCH CA
92694-2113
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-2446
  • Fax:
Mailing address:
  • Phone: 949-276-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number14401
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: