Provider Demographics
NPI:1639859374
Name:VASQUEZ, ELSHIA NICOLE (AMFT/APCC)
Entity Type:Individual
Prefix:
First Name:ELSHIA
Middle Name:NICOLE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:AMFT/APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WOODFALL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4621
Mailing Address - Country:US
Mailing Address - Phone:415-377-0822
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-450-0620
Practice Address - Fax:424-378-6329
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70459225700000X
CA140286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist