Healthcare Provider Details

I. General information

NPI: 1043822000
Provider Name (Legal Business Name): JESSICA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8241 PIONEER DR
ANCHORAGE AK
99504-4712
US

IV. Provider business mailing address

7521 BRAYTON DR
ANCHORAGE AK
99507-2667
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-5826
  • Fax:
Mailing address:
  • Phone: 907-929-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: