Healthcare Provider Details

I. General information

NPI: 1730017658
Provider Name (Legal Business Name): EDITH VASQUEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ED VASQUEZ

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 W EMPIRE AVE
BURBANK CA
91504-3212
US

IV. Provider business mailing address

2707 W EMPIRE AVE
BURBANK CA
91504-3212
US

V. Phone/Fax

Practice location:
  • Phone: 818-634-1163
  • Fax:
Mailing address:
  • Phone: 818-634-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: