Provider Demographics
NPI:1184235186
Name:VASQUEZ, LYDIA (RN, BSN, RNC-OB)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RN, BSN, RNC-OB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 JUDAH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1319
Mailing Address - Country:US
Mailing Address - Phone:415-794-4717
Mailing Address - Fax:
Practice Address - Street 1:1522 BUSH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5420
Practice Address - Country:US
Practice Address - Phone:415-821-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95188263163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse