Provider Demographics
NPI:1477111581
Name:VAZQUEZ MERCED, ERIC OMAR (NP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:OMAR
Last Name:VAZQUEZ MERCED
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 N FULLER AVE APT 245
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3075
Mailing Address - Country:US
Mailing Address - Phone:407-716-5757
Mailing Address - Fax:
Practice Address - Street 1:7705 SEVILLE AVE STE D
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6570
Practice Address - Country:US
Practice Address - Phone:323-582-6534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily