Provider Demographics
NPI:1851826135
Name:VASQUEZ, ADAN
Entity Type:Individual
Prefix:
First Name:ADAN
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32375 ELMO HWY APT A
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93250-9616
Mailing Address - Country:US
Mailing Address - Phone:661-428-4906
Mailing Address - Fax:661-725-1957
Practice Address - Street 1:828 HIGH ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2960
Practice Address - Country:US
Practice Address - Phone:661-725-2788
Practice Address - Fax:661-725-1957
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator