Provider Demographics
NPI:1760521322
Name:VAZQUEZ, LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3891 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8814
Mailing Address - Country:US
Mailing Address - Phone:626-422-5958
Mailing Address - Fax:
Practice Address - Street 1:1840 N HACIENDA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-931-6618
Practice Address - Fax:626-931-6610
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703841OtherMEDICAL
CA00A703841OtherMEDICAL