Provider Demographics
NPI:1831355015
Name:VAZQUEZ, MANUELA (MD)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7704
Mailing Address - Country:US
Mailing Address - Phone:949-644-2722
Mailing Address - Fax:949-760-5438
Practice Address - Street 1:1441 AVOCADO AVE STE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7704
Practice Address - Country:US
Practice Address - Phone:949-644-2722
Practice Address - Fax:949-760-5438
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology