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NPI Code Detail

MEDICARE: DESTINY VAZQUEZ

MEDICARE: DESTINY VAZQUEZ
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 Coordinator
2175T00000XPeer SpecialistCA

General Provider Information

NPI Number : 1639772585
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY VAZQUEZ
Provider Business Mailing Address
First Line : 4850 PEDLEY RD
Second Line :
City : JURUPA VALLEY
State : CA
Zip : 92509-3966
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4850 PEDLEY RD
Second Line :
City : JURUPA VALLEY
State : CA
Zip : 92509-3966
Country : US
Telephone Number : 951-416-1572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2020
Last Update Date : 07/10/2023

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Directions to “ DESTINY VAZQUEZ ” Practice Location

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