Healthcare Provider Details

I. General information

NPI: 1093265811
Provider Name (Legal Business Name): ALEXIS ADRIANA VAZQUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 S 4TH ST
EL CENTRO CA
92243-4749
US

IV. Provider business mailing address

1075 CAMINO DEL RIO S
SAN DIEGO CA
92108-3538
US

V. Phone/Fax

Practice location:
  • Phone: 760-594-9100
  • Fax: 619-291-0959
Mailing address:
  • Phone: 619-881-4500
  • Fax: 619-291-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number838451
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: