Healthcare Provider Details

I. General information

NPI: 1326403312
Provider Name (Legal Business Name): FATIMA MICAELA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W SHAW AVE # 107
FRESNO CA
93711-3229
US

IV. Provider business mailing address

2416 W SHAW AVE STE 114
FRESNO CA
93711-3303
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2115
  • Fax:
Mailing address:
  • Phone: 559-248-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC4811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: