Provider Demographics
NPI:1609254945
Name:VASQUEZ, FRANK JR (CADC-CAS)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:VASQUEZ
Suffix:JR
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 N CHESTNUT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1608
Mailing Address - Country:US
Mailing Address - Phone:559-252-5150
Mailing Address - Fax:559-252-5156
Practice Address - Street 1:3636 N 1ST ST STE 135&154
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6800
Practice Address - Country:US
Practice Address - Phone:559-225-1464
Practice Address - Fax:844-601-2973
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1407064843101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1082Medicaid