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General NPI Number Information
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NPI Number | 1609624956
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Entity Type | Individual
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Provider Name | VANITY MCKENZIE ESELEBOR PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 12566 VALLEY VIEW ST
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City | GARDEN GROVE
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State | CA
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Zip | 92845-2006
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Country | US
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Telephone | 999-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 8697 LA MESA BLVD STE C521
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City | LA MESA
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State | CA
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Zip | 91942-9565
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95041442
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 95359132
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License Number State | CA
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