Provider Demographics
NPI:1578710794
Name:VASQUEZ, ERNESTO
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 CROCKER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1311
Mailing Address - Country:US
Mailing Address - Phone:323-234-4445
Mailing Address - Fax:323-234-4447
Practice Address - Street 1:5807 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5303
Practice Address - Country:US
Practice Address - Phone:323-234-4445
Practice Address - Fax:323-234-4447
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator