1013695436 NPI number — MS. VANESSA BRYANNE KAMCHAMNAN HCA

Table of content: MS. VANESSA BRYANNE KAMCHAMNAN HCA (NPI 1013695436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013695436 NPI number — MS. VANESSA BRYANNE KAMCHAMNAN HCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMCHAMNAN
Provider First Name:
VANESSA
Provider Middle Name:
BRYANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
HCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROMERO
Provider Other First Name:
VANESSA
Provider Other Middle Name:
BRYANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013695436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6583 MESADA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91737-4313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-463-0865
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1162 E 19TH ST UNIT 1120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91784-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-602-0045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com