Healthcare Provider Details

I. General information

NPI: 1861961872
Provider Name (Legal Business Name): MARIA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N HIGHWAY 59 STE K
MERCED CA
95348-9405
US

IV. Provider business mailing address

587 STRAUSS CT
MADERA CA
93637-5657
US

V. Phone/Fax

Practice location:
  • Phone: 209-726-3090
  • Fax:
Mailing address:
  • Phone: 559-203-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109059
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: