Healthcare Provider Details

I. General information

NPI: 1811949258
Provider Name (Legal Business Name): JON J. VASQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/01/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S VAL VISTA DR STE A3-621
GILBERT AZ
85296-1374
US

IV. Provider business mailing address

PO BOX 2710
SCOTTSDALE AZ
85252-2710
US

V. Phone/Fax

Practice location:
  • Phone: 480-347-4648
  • Fax: 833-336-6898
Mailing address:
  • Phone: 480-882-6359
  • Fax: 480-882-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30428
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: