MEDICARE: MS. VANESSA SAMBRANO HERNANDEZ

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1124285044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA SAMBRANO HERNANDEZ

Provider Business Mailing Address
First Line	:	3050 CHICAGO AVE
Second Line	:	SUITE 180
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3418
Country	:	US
Telephone Number	:	951-686-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 CHICAGO AVE
Second Line	:	SUITE 180
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3418
Country	:	US
Telephone Number	:	951-686-8500
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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