Healthcare Provider Details

I. General information

NPI: 1467205864
Provider Name (Legal Business Name): ISABEL VACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24625 ARCH ST
NEWHALL CA
91321-1111
US

IV. Provider business mailing address

26460 SUMMIT CIR
SANTA CLARITA CA
91350-2991
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-2644
  • Fax: 661-288-2669
Mailing address:
  • Phone: 661-254-6630
  • Fax: 661-254-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: