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General NPI Number Information
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NPI Number | 1093683286
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Entity Type | Individual
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Provider Name | VANESSA CARLOS NP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 241 N. MACLAY AVE SUITE 100
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2909
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Country | US
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Telephone | 818-930-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 3833 SOURDOUGH RD
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City | ACTON
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State | CA
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Zip | 93510-1225
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Country | US
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Telephone | 818-930-4337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN95161183
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License Number State | CA
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