Provider Demographics
NPI:1679512776
Name:HO, VANESSA (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 PARK SIERRA DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3081
Mailing Address - Country:US
Mailing Address - Phone:951-637-9935
Mailing Address - Fax:951-637-0608
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3081
Practice Address - Country:US
Practice Address - Phone:951-637-9935
Practice Address - Fax:951-637-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH25716Medicare UPIN