Provider Demographics
NPI:1679713762
Name:VASQUEZ, LINDA A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 POSADA LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4056
Mailing Address - Country:US
Mailing Address - Phone:805-434-0770
Mailing Address - Fax:805-434-5124
Practice Address - Street 1:265 POSADA LN
Practice Address - Street 2:SUITE D
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4056
Practice Address - Country:US
Practice Address - Phone:805-434-0770
Practice Address - Fax:805-434-5124
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 202329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC603ZMedicare PIN