MEDICARE: AMY DANIELLE VANEGAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1043794985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DANIELLE VANEGAS

Provider Business Mailing Address
First Line	:	4820 BUSINESS CENTER DR STE 210
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-1696
Country	:	US
Telephone Number	:	707-977-5573
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 BUSINESS CENTER DR STE 210
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-1696
Country	:	US
Telephone Number	:	707-977-5573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	03/16/2026

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