Healthcare Provider Details

I. General information

NPI: 1003377433
Provider Name (Legal Business Name): VANESSA LINDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA LINDO

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KNOLLCREST DR STE 101
REDDING CA
96002-0181
US

IV. Provider business mailing address

2171 FERENTZ TRCE
NORCROSS GA
30071-3757
US

V. Phone/Fax

Practice location:
  • Phone: 530-392-4399
  • Fax: 530-903-4226
Mailing address:
  • Phone: 770-865-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66269
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: