Provider Demographics
NPI:1053086520
Name:VAZQUEZ, TERRI LYNN
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1424
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-1424
Mailing Address - Country:US
Mailing Address - Phone:707-463-0405
Mailing Address - Fax:707-313-1274
Practice Address - Street 1:410 JONES ST STE C1
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5491
Practice Address - Country:US
Practice Address - Phone:707-463-0405
Practice Address - Fax:707-313-1274
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker