Provider Demographics
NPI:1588207203
Name:VAZQUEZ, JACQUELIN MARLENE (MSW)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:MARLENE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7851 ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3511
Mailing Address - Country:US
Mailing Address - Phone:626-675-8344
Mailing Address - Fax:
Practice Address - Street 1:711 E BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5930
Practice Address - Country:US
Practice Address - Phone:657-276-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA892881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical