Vanessa Icazbalceta-Soto

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

15849 Issued in CA

Practice address

9265 Sky Park CT Ste 100
San Diego, CA 92123-4375

Phone

(706) 524-7134

NPI assigned

Sep 17, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Vanessa Icazbalceta Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Serene Health

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1649809526

  Professional

  Medicare reassignment NPD
• Serene Health Ipa

  • Psychiatric/Mental Health Nurse Practitioner
  • Aiken, SC
  • NPI 1235950080
  NPD
• Amanecer Community Counseling Service, a Non-Profit Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Los Angeles, CA
  • NPI 1053449900
  NPD (past)
• Amanecer Community Counseling Service, a Non-Profit Corporation

  • Community/Behavioral Health Agency
  • Lynwood, CA
  • NPI 1962882332
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1083264519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N BRAND BLVD #200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "912031519",
            "telephone_number": "562-888-0285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9265 SKY PARK CT STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234375",
            "telephone_number": "706-524-7134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 N Brand Blvd Unit 200",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "91203",
            "country_code": "US",
            "telephone_number": "562-888-0285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ICAZBALCETA-SOTO",
        "first_name": "VANESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "15849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VANESSA",
            "last_name": "ICAZBALCETA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.