Provider Demographics
NPI:1942080353
Name:VASQUEZ, MARISSA LIANA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LIANA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ESPERANZA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5775
Mailing Address - Country:US
Mailing Address - Phone:909-217-5205
Mailing Address - Fax:
Practice Address - Street 1:2101 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4521
Practice Address - Country:US
Practice Address - Phone:888-777-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)