Basic Information
| Provider Information | |||||||||
| NPI: | 1245781335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASHIM | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSPA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BINDI | ||||||||
| OtherFirstName: | VANESSA | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSPA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1150 W EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940402518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506955008 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1150 W EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940402518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506955008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2016 | ||||||||
| LastUpdateDate: | 11/16/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110-005566 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1245781335 | 01 | VA | CORVEL | OTHER | 1245781335 | 05 | VA | MEDICAID | 1245781335 | 01 | VA | HUMANA | OTHER | 1245781335 | 01 | VA | MULTIPLAN | OTHER | 1245781335 | 05 | NC | MEDICAID | 1245781335 | 01 | VA | USA MANAGED CARE | OTHER | 1245781335 | 01 | VA | OPTIMA HEALTH | OTHER | 1245781335 | 01 | VA | TRICARE/CHAMPUS | OTHER |