Provider Demographics
NPI:1790480960
Name:VAZQUEZ, JAMIL CESAR
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:CESAR
Last Name:VAZQUEZ
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 1:8015B W SANDIA CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116-5500
Mailing Address - Country:US
Mailing Address - Phone:779-875-1413
Mailing Address - Fax:
Practice Address - Street 1:8015B W SANDIA CIR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87116-5500
Practice Address - Country:US
Practice Address - Phone:779-875-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health