Provider Demographics
NPI:1871847012
Name:VASQUEZ, MICHELLE ELAINE (NP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 LOCUST AVE UNIT 414
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5857
Mailing Address - Country:US
Mailing Address - Phone:714-342-1695
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE N152
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2215
Practice Address - Country:US
Practice Address - Phone:714-285-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543429363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty