Provider Demographics
NPI:1093440828
Name:VAZQUEZ, JOANNA LIZETH (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LIZETH
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:FNP
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 432
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:CA
Mailing Address - Zip Code:92249-0432
Mailing Address - Country:US
Mailing Address - Phone:760-554-9318
Mailing Address - Fax:
Practice Address - Street 1:1671 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-5420
Practice Address - Country:US
Practice Address - Phone:760-592-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily