Healthcare Provider Details

I. General information

NPI: 1629136965
Provider Name (Legal Business Name): MIGUEL VASQUEZ MD ANN CARROLL MD A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 GREEN VALLEY RD SUITE A
FREEDOM CA
95019
US

IV. Provider business mailing address

243 GREEN VALLEY RD SUITE A
FREEDOM CA
95019
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-4595
  • Fax: 831-728-4598
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG38080
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA33076
License Number StateCA

VIII. Authorized Official

Name: MIGUEL VASQUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 831-728-4595