Provider Demographics
NPI:1497739908
Name:COAKER, CECILE VASQUEZ (PT)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:VASQUEZ
Last Name:COAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CECILE
Other - Middle Name:SAMSON
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5313
Mailing Address - Country:US
Mailing Address - Phone:831-375-1885
Mailing Address - Fax:831-375-7436
Practice Address - Street 1:2230 GLADSTONE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5102
Practice Address - Country:US
Practice Address - Phone:925-427-5155
Practice Address - Fax:925-427-9552
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT282431OtherMEDICARE PTAN