Provider Demographics
NPI:1740614114
Name:VASQUEZ, JEFFREY EDWARD
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EDWARD
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2521
Mailing Address - Country:US
Mailing Address - Phone:562-965-0737
Mailing Address - Fax:562-695-0413
Practice Address - Street 1:8207 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2521
Practice Address - Country:US
Practice Address - Phone:562-965-0737
Practice Address - Fax:562-695-0413
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)