Provider Demographics
NPI:1841591484
Name:VASQUEZ, PHILIPPE ALEJANDRO (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIPPE
Middle Name:ALEJANDRO
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
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Mailing Address - Street 1:2288 AUBURN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821
Mailing Address - Country:US
Mailing Address - Phone:916-879-0294
Mailing Address - Fax:
Practice Address - Street 1:2288 AUBURN BLVD
Practice Address - Street 2:SUTIE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1618
Practice Address - Country:US
Practice Address - Phone:916-568-8338
Practice Address - Fax:916-925-3985
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant