Healthcare Provider Details

I. General information

NPI: 1295517480
Provider Name (Legal Business Name): PAOLA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 W ADAMS BLVD
LOS ANGELES CA
90018-3515
US

IV. Provider business mailing address

27030 PLUM ST
PERRIS CA
92570-7090
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-2695
  • Fax:
Mailing address:
  • Phone: 909-828-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA4202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: