Healthcare Provider Details

I. General information

NPI: 1093996530
Provider Name (Legal Business Name): KATHY VASQUEZ BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY VAZQUEZ

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LATHAM
HEMET CA
92543
US

IV. Provider business mailing address

10570 SE WASHINGTON ST SUITE 202
PORTLAND OR
97216
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-9948
  • Fax:
Mailing address:
  • Phone: 503-257-6800
  • Fax: 503-257-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3397
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 3397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: