Healthcare Provider Details

I. General information

NPI: 1598143919
Provider Name (Legal Business Name): VANESSA DEHESA-WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 06/03/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41593 WINCHESTER RD STE 200
TEMECULA CA
92590-4857
US

IV. Provider business mailing address

PO BOX 1024
WILDOMAR CA
92595-1024
US

V. Phone/Fax

Practice location:
  • Phone: 951-783-9096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122335
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: