Provider Demographics
NPI:1801382072
Name:VASQUEZ, JEANETTE GUADALUPE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:GUADALUPE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6614
Mailing Address - Country:US
Mailing Address - Phone:714-922-4100
Mailing Address - Fax:714-532-2522
Practice Address - Street 1:801 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6614
Practice Address - Country:US
Practice Address - Phone:714-922-4100
Practice Address - Fax:714-532-2522
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant