Provider Demographics
NPI:1194463919
Name:VASQUEZ, PHILLIP SEBASTIAN (HAD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SEBASTIAN
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 DEVONPORT CT
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5251
Mailing Address - Country:US
Mailing Address - Phone:951-805-7597
Mailing Address - Fax:
Practice Address - Street 1:301 E ALESSANDRO BLVD STE 3C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2464
Practice Address - Country:US
Practice Address - Phone:951-329-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8730237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist