Healthcare Provider Details

I. General information

NPI: 1407505852
Provider Name (Legal Business Name): ELVIA MIREYA VAZQUEZ MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W LEGION RD
BRAWLEY CA
92227-7780
US

IV. Provider business mailing address

1636 E ALAMO RD
HOLTVILLE CA
92250-9632
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-3737
  • Fax:
Mailing address:
  • Phone: 760-890-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: