Provider Demographics
NPI:1447405352
Name:VASQUEZ, VANESSA BERNADINE-MARIE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:BERNADINE-MARIE
Last Name:VASQUEZ
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 1:5021 YOKUT CT
Mailing Address - Street 2:
Mailing Address - City:WELDON
Mailing Address - State:CA
Mailing Address - Zip Code:93283-9724
Mailing Address - Country:US
Mailing Address - Phone:760-223-2515
Mailing Address - Fax:
Practice Address - Street 1:2731 NUGGET AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93283
Practice Address - Country:US
Practice Address - Phone:760-379-3412
Practice Address - Fax:760-379-5335
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator