Healthcare Provider Details

I. General information

NPI: 1427840131
Provider Name (Legal Business Name): ERICK VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 COUNTRY DR
FREMONT CA
94536-5356
US

IV. Provider business mailing address

2320 COOLEY AVE
EAST PALO ALTO CA
94303-1635
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-4242
  • Fax:
Mailing address:
  • Phone: 650-776-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number49264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: