Healthcare Provider Details

I. General information

NPI: 1346108321
Provider Name (Legal Business Name): JESSICA RAE VAZQUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LEAL

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N LINCOLN ST
BURBANK CA
91506-1211
US

IV. Provider business mailing address

1303 N LINCOLN ST
BURBANK CA
91506-1211
US

V. Phone/Fax

Practice location:
  • Phone: 213-215-6812
  • Fax:
Mailing address:
  • Phone: 213-215-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95150839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: