Provider Demographics
NPI:1790052819
Name:VASQUEZ, EMIL FLORENDO (PAC)
Entity Type:Individual
Prefix:MR
First Name:EMIL
Middle Name:FLORENDO
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9119 HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3121
Mailing Address - Country:US
Mailing Address - Phone:818-763-8836
Mailing Address - Fax:818-221-4747
Practice Address - Street 1:9119 HASKELL AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343
Practice Address - Country:US
Practice Address - Phone:818-763-8836
Practice Address - Fax:818-221-4747
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant