Provider Demographics
NPI:1740743236
Name:VASQUEZ, JEAN JR (BA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:VASQUEZ
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 POTRERO GRANDE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4167
Mailing Address - Country:US
Mailing Address - Phone:626-872-0868
Mailing Address - Fax:626-508-1186
Practice Address - Street 1:1600 POTRERO GRANDE DR STE 7
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-4167
Practice Address - Country:US
Practice Address - Phone:626-872-0868
Practice Address - Fax:626-508-1186
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other