Provider Demographics
NPI:1467158329
Name:VAZQUEZ, GIOVANNA MARIE
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:MARIE
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 1:7958 MISSION CENTER CT UNIT F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1456
Mailing Address - Country:US
Mailing Address - Phone:626-251-8134
Mailing Address - Fax:
Practice Address - Street 1:2727 CAMINO DEL RIO S STE 123
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3739
Practice Address - Country:US
Practice Address - Phone:626-251-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696468164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse