Healthcare Provider Details

I. General information

NPI: 1881255230
Provider Name (Legal Business Name): ASHLEY MARIE VASQUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY MARIE JANICKI PA

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 W CHANDLER BLVD STE 3
CHANDLER AZ
85226-3744
US

IV. Provider business mailing address

7314 E MILAGRO AVE
MESA AZ
85209-4965
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-4334
  • Fax:
Mailing address:
  • Phone: 480-201-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: