Provider Demographics
NPI:1265157861
Name:VAZQUEZ, ESMERALDA ELIZABETH (RDN)
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:ELIZABETH
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74818 VELIE WAY STE 12
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1924
Mailing Address - Country:US
Mailing Address - Phone:760-702-6394
Mailing Address - Fax:
Practice Address - Street 1:74818 VELIE WAY STE 12
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1924
Practice Address - Country:US
Practice Address - Phone:760-702-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86155763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered