Provider Demographics
NPI:1720620008
Name:VAZQUEZ, VEOLA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:VEOLA
Middle Name:E
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8432 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3206
Mailing Address - Country:US
Mailing Address - Phone:951-552-8627
Mailing Address - Fax:
Practice Address - Street 1:2900 ADAMS ST STE C10
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-7915
Practice Address - Country:US
Practice Address - Phone:951-552-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical