Provider Demographics
NPI:1851561971
Name:VAZQUEZ, JULI PETKUS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULI
Middle Name:PETKUS
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 CATAMARAN WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4532
Mailing Address - Country:US
Mailing Address - Phone:619-591-9552
Mailing Address - Fax:
Practice Address - Street 1:2538 CATAMARAN WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4532
Practice Address - Country:US
Practice Address - Phone:619-591-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist