Provider Demographics
NPI:1093996530
Name:VASQUEZ, KATHY (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10570 SE WASHINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216
Mailing Address - Country:US
Mailing Address - Phone:503-257-6800
Mailing Address - Fax:503-257-6810
Practice Address - Street 1:1001 E LATHAM
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-925-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3397237700000X
CAHA 3397237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist