Provider Demographics
NPI:1760739528
Name:VASQUEZ, REBECCA HOPE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HOPE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:HOPE
Other - Last Name:HARBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3124 B ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2319
Mailing Address - Country:US
Mailing Address - Phone:347-335-2117
Mailing Address - Fax:
Practice Address - Street 1:4183 ADAMS AVE
Practice Address - Street 2:ZEN SANCTUARY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2537
Practice Address - Country:US
Practice Address - Phone:619-928-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist