Provider Demographics
NPI:1689747032
Name:VAZQUEZ, MACARIO RUIZ (MD)
Entity Type:Individual
Prefix:
First Name:MACARIO
Middle Name:RUIZ
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95665
Mailing Address - Country:US
Mailing Address - Phone:209-296-6811
Mailing Address - Fax:209-296-6827
Practice Address - Street 1:19881 HWY 88
Practice Address - Street 2:STE #5
Practice Address - City:PINE GROVE
Practice Address - State:CA
Practice Address - Zip Code:95665
Practice Address - Country:US
Practice Address - Phone:209-296-6811
Practice Address - Fax:209-296-6827
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42097208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice