Provider Demographics
NPI:1841243151
Name:VAZQUEZ, CAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 EASTERN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3003
Mailing Address - Country:US
Mailing Address - Phone:562-927-6847
Mailing Address - Fax:
Practice Address - Street 1:6501 EASTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-3003
Practice Address - Country:US
Practice Address - Phone:562-927-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV7774347OtherDEA NUMBER
CAD34248Medicare UPIN