Healthcare Provider Details

I. General information

NPI: 1396945770
Provider Name (Legal Business Name): VANESSA LAQUINTE NEAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA LAQUINTE

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 09/12/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 CAMINO MIRA COSTA
SAN CLEMENTE CA
92672-3512
US

IV. Provider business mailing address

3553 CAMINO MIRA COSTA STE D
SAN CLEMENTE CA
92672-3512
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-7737
  • Fax: 949-336-1949
Mailing address:
  • Phone: 949-200-7737
  • Fax: 949-336-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0116016592
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: