Healthcare Provider Details

I. General information

NPI: 1336780188
Provider Name (Legal Business Name): DANIEL ENRIQUE VASQUEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 1000
GARDENA CA
90248-4255
US

IV. Provider business mailing address

3745 LONG BEACH BLVD STE 100
LONG BEACH CA
90807-3340
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-9115
  • Fax:
Mailing address:
  • Phone: 855-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberF5766405
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number15150
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: