Healthcare Provider Details

I. General information

NPI: 1013625086
Provider Name (Legal Business Name): DANESSA VENITA COLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

24510 NORTHWEST FWY STE 120
CYPRESS TX
77429-2199
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-4616
  • Fax:
Mailing address:
  • Phone: 346-618-3460
  • Fax: 346-618-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP95035602
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95035602
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1098460
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: