Provider Demographics
NPI:1124478482
Name:VANEGAS, GINA (MED, PHD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:VANEGAS
Suffix:
Gender:F
Credentials:MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W HIGHWAY 246
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9719
Mailing Address - Country:US
Mailing Address - Phone:805-633-0810
Mailing Address - Fax:
Practice Address - Street 1:85 W HIGHWAY 246
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9719
Practice Address - Country:US
Practice Address - Phone:805-633-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33358103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist