Healthcare Provider Details

I. General information

NPI: 1861311755
Provider Name (Legal Business Name): URIAN VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ALTAIR AVE
LOMPOC CA
93436-1423
US

IV. Provider business mailing address

1105 W CYPRESS AVE APT I
LOMPOC CA
93436-6423
US

V. Phone/Fax

Practice location:
  • Phone: 805-743-4325
  • Fax:
Mailing address:
  • Phone: 805-670-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: