Healthcare Provider Details

I. General information

NPI: 1912867110
Provider Name (Legal Business Name): VANESSA HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MORAGA AVE STE B103
SAN DIEGO CA
92117-5352
US

IV. Provider business mailing address

15766 CAMINO CRISALIDA
SAN DIEGO CA
92127-5834
US

V. Phone/Fax

Practice location:
  • Phone: 858-799-0855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: