MEDICARE: VANESSA MARIA KALIS NP

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	363LA2100X	Acute Care Nurse Practitioner	14401	CA
2	364S00000X	Clinical Nurse Specialist	1901	CA

General Provider Information

NPI Number	:	1629057237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA MARIA KALIS NP

Provider Business Mailing Address
First Line	:	333 CORPORATE DR
Second Line	:	STE 102
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-2113
Country	:	US
Telephone Number	:	949-276-2446
Fax Number	:

Provider Business Practice Location Address
First Line	:	27800 MEDICAL CENTER RD
Second Line	:	SUITE 222
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6410
Country	:	US
Telephone Number	:	949-276-2446
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	08/17/2018

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