MEDICARE: MARILYN E 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
1	106S00000X	Behavior Technician	RBT-22-203215	CA

General Provider Information

NPI Number	:	1952040404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN E VASQUEZ

Provider Business Mailing Address
First Line	:	11726 LEMAY ST APT 13
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1639
Country	:	US
Telephone Number	:	747-218-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4271
Country	:	US
Telephone Number	:	833-669-4222
Fax Number	:

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “ MARILYN E VASQUEZ ” Practice Location

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