Provider Demographics
NPI:1457245706
Name:VASQUEZ, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
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 1:9907 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:WATTS
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3112
Mailing Address - Country:US
Mailing Address - Phone:323-890-6415
Mailing Address - Fax:
Practice Address - Street 1:9907 GRAPE ST
Practice Address - Street 2:
Practice Address - City:WATTS
Practice Address - State:CA
Practice Address - Zip Code:90002-3112
Practice Address - Country:US
Practice Address - Phone:323-890-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist