Provider Demographics
NPI:1689839300
Name:VAZQUEZ, NANNETTE (MSW)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
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 1:815 COLORADO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1744
Mailing Address - Country:US
Mailing Address - Phone:323-543-2800
Mailing Address - Fax:323-978-1263
Practice Address - Street 1:50 E FOOTHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2314
Practice Address - Country:US
Practice Address - Phone:626-919-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36293101YM0800X
CALCSW988101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN817OtherLA COUNTY DMH