Healthcare Provider Details

I. General information

NPI: 1669333258
Provider Name (Legal Business Name): VANESSA JUNGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA MARTINEZ

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 HIGHWAY 202
TEHACHAPI CA
93561-5558
US

IV. Provider business mailing address

702 WORKMAN ST
BAKERSFIELD CA
93307-6800
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4402
  • Fax:
Mailing address:
  • Phone: 661-335-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110883
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: