Healthcare Provider Details

I. General information

NPI: 1841243151
Provider Name (Legal Business Name): CAROLINA VAZQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/25/2024
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 EASTERN AVE SUITE A
BELL GARDENS CA
90201-3003
US

IV. Provider business mailing address

6501 EASTERN AVE SUITE A
BELL GARDENS CA
90201-3003
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-6847
  • Fax:
Mailing address:
  • Phone: 562-927-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG81758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: