Healthcare Provider Details

I. General information

NPI: 1922516574
Provider Name (Legal Business Name): CYNTHIA MAURICE VAZQUEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10568 MAGNOLIA AVE STE 102
ANAHEIM CA
92804-5864
US

IV. Provider business mailing address

2043 SAN FRANCISCO AVE
LONG BEACH CA
90806-4146
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-7233
  • Fax:
Mailing address:
  • Phone: 562-889-4256
  • Fax: 888-891-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-38282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: