Healthcare Provider Details

I. General information

NPI: 1023210341
Provider Name (Legal Business Name): CARLA VACCAREZZA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 LANGPORT DR
SUNNYVALE CA
94087-4677
US

IV. Provider business mailing address

1666 LANGPORT DR
SUNNYVALE CA
94087-4677
US

V. Phone/Fax

Practice location:
  • Phone: 408-406-7162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: