Healthcare Provider Details

I. General information

NPI: 1700749348
Provider Name (Legal Business Name): NATALIA VINCENTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 ANGELUCCI ST UNIT 2M
SAN DIEGO CA
92111-4432
US

IV. Provider business mailing address

3505 ANGELUCCI ST UNIT 2M
SAN DIEGO CA
92111-4432
US

V. Phone/Fax

Practice location:
  • Phone: 818-669-4017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number210125467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: