Healthcare Provider Details

I. General information

NPI: 1639722440
Provider Name (Legal Business Name): SARA VAZQUEZ-CUTLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2019
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 N FOWLER AVE APT 113
CLOVIS CA
93611-6695
US

IV. Provider business mailing address

745 N FOWLER AVE APT 113
CLOVIS CA
93611-6695
US

V. Phone/Fax

Practice location:
  • Phone: 559-458-3883
  • Fax:
Mailing address:
  • Phone: 559-458-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143622
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114459
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT143622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: