Healthcare Provider Details

I. General information

NPI: 1134893225
Provider Name (Legal Business Name): ALBERTO VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALBERTO VASQUEZ

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 W PICO AVE STE 23
EL CENTRO CA
92243-1377
US

IV. Provider business mailing address

1402 W PICO AVE STE 23
EL CENTRO CA
92243-1377
US

V. Phone/Fax

Practice location:
  • Phone: 760-556-8185
  • Fax:
Mailing address:
  • Phone: 760-556-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: