Healthcare Provider Details

I. General information

NPI: 1487370045
Provider Name (Legal Business Name): VIVIANA ESPERANZA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 DOVER PKWY
DELANO CA
93215-3440
US

IV. Provider business mailing address

355 DOVER PKWY
DELANO CA
93215-3440
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-2788
  • Fax: 661-725-1957
Mailing address:
  • Phone: 661-725-2788
  • Fax: 661-725-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: