Provider Demographics
NPI:1184729048
Name:TSUDA-NGUYEN, VANESSA L (DO)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:L
Last Name:TSUDA-NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LEE
Other - Last Name:TSUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1104 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3875
Mailing Address - Country:US
Mailing Address - Phone:916-520-4466
Mailing Address - Fax:877-585-0065
Practice Address - Street 1:1104 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3875
Practice Address - Country:US
Practice Address - Phone:916-520-4466
Practice Address - Fax:877-585-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A8745OtherCA MEDICAL LICENSE
CAI15275Medicare UPIN
CA20A8745OtherCA MEDICAL LICENSE