Healthcare Provider Details

I. General information

NPI: 1760973150
Provider Name (Legal Business Name): SULEMA A VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

IV. Provider business mailing address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-7100
  • Fax: 559-498-7111
Mailing address:
  • Phone: 559-498-7100
  • Fax: 559-498-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: