Basic Information
| Provider Information | |||||||||
| NPI: | 1588705941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILKENS | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CCJS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1217 S. SECOND STREET APT. A | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918010563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239977320 | ||||||||
| FaxNumber: | 3232933327 | ||||||||
| Practice Location | |||||||||
| Address1: | 3875 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900621105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232904361 | ||||||||
| FaxNumber: | 3232933327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.