Basic Information
Provider Information
NPI: 1003298449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALBA
FirstName: VANESSA
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1000
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933021000
CountryCode: US
TelephoneNumber: 6617587321
FaxNumber: 6617587303
Practice Location
Address1: 1401 L ST
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933014522
CountryCode: US
TelephoneNumber: 6618686100
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2015
LastUpdateDate: 10/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X  Y Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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