Provider Demographics
NPI:1457659732
Name:VASQUEZ, REMEDIOS S
Entity Type:Individual
Prefix:
First Name:REMEDIOS
Middle Name:S
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 1:18245 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-5519
Mailing Address - Country:US
Mailing Address - Phone:760-947-2099
Mailing Address - Fax:760-947-2099
Practice Address - Street 1:18245 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-5519
Practice Address - Country:US
Practice Address - Phone:760-947-2099
Practice Address - Fax:760-947-2099
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366423793310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility