Provider Demographics
NPI:1851690671
Name:VAZQUEZ, ORLANDO CALEB (PT)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:CALEB
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 ROCKWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4401
Mailing Address - Country:US
Mailing Address - Phone:760-890-5868
Mailing Address - Fax:760-890-5780
Practice Address - Street 1:2451 ROCKWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4401
Practice Address - Country:US
Practice Address - Phone:760-890-5868
Practice Address - Fax:760-890-5780
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT37648OtherPHYSICAL THERAPY BOARD OF CALIFORNIA