Healthcare Provider Details

I. General information

NPI: 1104159458
Provider Name (Legal Business Name): LAURIE MORGAN VAZQUEZ RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

4210 PUENTE WAY
SACRAMENTO CA
95864-3015
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-9436
  • Fax: 916-843-9441
Mailing address:
  • Phone: 916-482-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number328199
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number328199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: