Healthcare Provider Details

I. General information

NPI: 1467379263
Provider Name (Legal Business Name): FERNANDA JANONE DOS REIS E VAZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4868 MONROE AVE
SAN DIEGO CA
92115-3245
US

IV. Provider business mailing address

4868 MONROE AVE
SAN DIEGO CA
92115-3245
US

V. Phone/Fax

Practice location:
  • Phone: 619-929-9163
  • Fax:
Mailing address:
  • Phone: 619-929-9163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: