Healthcare Provider Details

I. General information

NPI: 1275000341
Provider Name (Legal Business Name): JOSE LUS VAZQUEZ RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N VERMONT AVE
LOS ANGELES CA
90027-5329
US

IV. Provider business mailing address

562 LEWIS ST
POMONA CA
91768-3447
US

V. Phone/Fax

Practice location:
  • Phone: 909-282-6800
  • Fax:
Mailing address:
  • Phone: 909-282-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number31411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: