Provider Demographics
NPI:1457922742
Name:VAZQUEZ, DANIELA PERALTA (MA)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:PERALTA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3420
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1420
Mailing Address - Country:US
Mailing Address - Phone:619-363-2068
Mailing Address - Fax:
Practice Address - Street 1:1010 TURQUOISE ST STE 303
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1268
Practice Address - Country:US
Practice Address - Phone:858-255-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT123015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist