Healthcare Provider Details

I. General information

NPI: 1689449415
Provider Name (Legal Business Name): OLIVIA VAZQUEZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 LOCUST ST
MODESTO CA
95351-2699
US

IV. Provider business mailing address

1904 RICHLAND AVE BLDG F
CERES CA
95307-4562
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-1906
  • Fax:
Mailing address:
  • Phone: 209-525-2092
  • Fax: 209-541-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC13153
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: