Provider Demographics
NPI:1861173619
Name:ARNOLD, VANESSA NICOLE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICOLE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ARNOLD
Other - Last Name:KVILVANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:218 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6118
Mailing Address - Country:US
Mailing Address - Phone:714-720-0909
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4469
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician