Healthcare Provider Details

I. General information

NPI: 1386982965
Provider Name (Legal Business Name): GUADALUPE VASQUEZ PSY,D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W SHAW AVE 200
FRESNO CA
93704-2515
US

IV. Provider business mailing address

516 W SHAW AVE 200
FRESNO CA
93704-2515
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-2571
  • Fax: 559-221-2660
Mailing address:
  • Phone: 559-221-2571
  • Fax: 559-221-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 22825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: