Provider Demographics
NPI:1174679146
Name:VAZQUEZ, CITLA INEZ
Entity Type:Individual
Prefix:
First Name:CITLA
Middle Name:INEZ
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 1:1400 CALCUTTA DR APT 120
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-4623
Mailing Address - Country:US
Mailing Address - Phone:559-625-1181
Mailing Address - Fax:
Practice Address - Street 1:1217 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1820
Practice Address - Country:US
Practice Address - Phone:661-758-4029
Practice Address - Fax:661-758-0891
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health