Healthcare Provider Details

I. General information

NPI: 1609254945
Provider Name (Legal Business Name): FRANK VASQUEZ JR. CADC-CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 135&154
FRESNO CA
93726-6800
US

IV. Provider business mailing address

3170 N CHESTNUT AVE STE 105
FRESNO CA
93703-1608
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-1464
  • Fax: 844-601-2973
Mailing address:
  • Phone: 559-252-5150
  • Fax: 559-252-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1407064843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: