Healthcare Provider Details

I. General information

NPI: 1144132937
Provider Name (Legal Business Name): VANESSA VASCONEZ RCIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 COACHWHIP AVE
LANCASTER SC
29720-0370
US

IV. Provider business mailing address

4316 COACHWHIP AVE
LANCASTER SC
29720-0370
US

V. Phone/Fax

Practice location:
  • Phone: 571-334-9452
  • Fax:
Mailing address:
  • Phone: 571-334-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: