MEDICARE: OLIVIA VASQUEZ MORALES NP-C

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
1	363LF0000X	Family Nurse Practitioner	NP 21123	CA
2	363L00000X	Nurse Practitioner	21123	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DU4034-P01528407	OTHER	CA	RAILROAD MEDICARE
3	DU5182-P01528202	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619246006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA VASQUEZ MORALES NP-C

Provider Business Mailing Address
First Line	:	18077 OUTER HWY 18
Second Line	:	SUITE 100
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2197
Country	:	US
Telephone Number	:	760-946-8169
Fax Number	:

Provider Business Practice Location Address
First Line	:	18077 OUTER HWY 18
Second Line	:	SUITE 100
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2197
Country	:	US
Telephone Number	:	760-946-8169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	01/01/2017

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