Healthcare Provider Details

I. General information

NPI: 1013298173
Provider Name (Legal Business Name): VANESSA REZOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 17TH ST STE 404
SAN FRANCISCO CA
94110-1259
US

IV. Provider business mailing address

551 COASTVIEW CT
BAY POINT CA
94565-6798
US

V. Phone/Fax

Practice location:
  • Phone: 415-437-3990
  • Fax:
Mailing address:
  • Phone: 925-864-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: