Basic Information
Provider Information
NPI: 1407179153
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOWD
FirstName: VANESSA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 EAST CENTER AVE.
Address2:  
City: VISALIA
State: CA
PostalCode: 932916331
CountryCode: US
TelephoneNumber: 5597374700
FaxNumber: 5597374782
Practice Location
Address1: 1107 WEST POPLAR AVE.
Address2:  
City: PORTERVILLE
State: CA
PostalCode: 932575839
CountryCode: US
TelephoneNumber: 5597817242
FaxNumber: 5597933542
Other Information
ProviderEnumerationDate: 03/09/2010
LastUpdateDate: 08/24/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA20729CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


Home