Healthcare Provider Details

I. General information

NPI: 1124955463
Provider Name (Legal Business Name): VANESSA DOSOO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 MISSION GORGE PL APT 551
SAN DIEGO CA
92120-4190
US

IV. Provider business mailing address

4560 MISSION GORGE PL APT 551
SAN DIEGO CA
92120-4190
US

V. Phone/Fax

Practice location:
  • Phone: 619-209-9304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number95243353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: