Provider Demographics
NPI:1083302806
Name:VASQUEZ, ROSA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:MARIA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 LOMITA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2086
Mailing Address - Country:US
Mailing Address - Phone:310-602-2550
Mailing Address - Fax:310-326-7205
Practice Address - Street 1:1403 LOMITA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2086
Practice Address - Country:US
Practice Address - Phone:310-602-2550
Practice Address - Fax:310-326-7205
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program