Healthcare Provider Details

I. General information

NPI: 1336521681
Provider Name (Legal Business Name): ALBERT VASQUEZ P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 TRAILSIDE CIR
CONCORD CA
94518-2185
US

IV. Provider business mailing address

1180 TRAILSIDE CIR
CONCORD CA
94518-2185
US

V. Phone/Fax

Practice location:
  • Phone: 209-499-9037
  • Fax:
Mailing address:
  • Phone: 209-499-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: