Healthcare Provider Details

I. General information

NPI: 1750182374
Provider Name (Legal Business Name): MRS. VANESSA CORTINAS GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 RUNNYMEDE ST
VAN NUYS CA
91405-1435
US

IV. Provider business mailing address

5255 ZELZAH AVE APT 107
ENCINO CA
91316-2150
US

V. Phone/Fax

Practice location:
  • Phone: 818-389-1184
  • Fax:
Mailing address:
  • Phone: 310-291-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberC42D8EC41C
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: