Provider Demographics
NPI:1053907279
Name:VO, VANNA
Entity type:Individual
Prefix:
First Name:VANNA
Middle Name:
Last Name:VO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SANDY CAPE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5800
Mailing Address - Country:US
Mailing Address - Phone:619-565-8960
Mailing Address - Fax:
Practice Address - Street 1:9888 CARROLL CENTRE RD STE 118
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4580
Practice Address - Country:US
Practice Address - Phone:858-354-1304
Practice Address - Fax:858-210-7177
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA59746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant