MEDICARE: DR. VANESSA ETIENNE

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	390200000X	Student in an Organized Health Care Education/Training Program	17443-I	PR

General Provider Information

NPI Number	:	1396627824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA ETIENNE

Provider Business Mailing Address
First Line	:	PO BOX 141174
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-1174
Country	:	US
Telephone Number	:	229-395-5645
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR. NUM 2, KM. 11.7
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959
Country	:	US
Telephone Number	:	787-474-8282
Fax Number	:

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

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	05/14/2026

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