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NPI Code Detail

MEDICARE: EDDIE VASQUEZ

MEDICARE: EDDIE VASQUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorN3336004CA

General Provider Information

NPI Number : 1255505681
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDDIE VASQUEZ
Provider Business Mailing Address
First Line : 795 WILLOW RD BLDG 347-B
Second Line :
City : MENLO PARK
State : CA
Zip : 94025-2539
Country : US
Telephone Number : 650-380-6149
Fax Number : 650-952-5846
Provider Business Practice Location Address
First Line : 505 CYPRESS AVE
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-2922
Country : US
Telephone Number : 650-380-6149
Fax Number : 650-952-5846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2008
Last Update Date : 04/16/2008

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Directions to “ EDDIE VASQUEZ ” Practice Location

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