Provider Demographics
NPI:1700419959
Name:VAZQUEZ, ALICIA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:NICOLE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 MISSION GORGE RD STE O
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3040
Mailing Address - Country:US
Mailing Address - Phone:619-383-6868
Mailing Address - Fax:
Practice Address - Street 1:10201 MISSION GORGE RD STE O
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3040
Practice Address - Country:US
Practice Address - Phone:619-383-6868
Practice Address - Fax:619-330-2760
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty