Provider Demographics
NPI:1710186556
Name:VASQUEZ, ALBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALBA
Other - Middle Name:
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6360 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 512
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5601
Mailing Address - Country:US
Mailing Address - Phone:323-651-0933
Mailing Address - Fax:323-651-0936
Practice Address - Street 1:6360 WILSHIRE BLVD
Practice Address - Street 2:SUITE 512
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5601
Practice Address - Country:US
Practice Address - Phone:323-651-0933
Practice Address - Fax:323-651-0936
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist