Healthcare Provider Details

I. General information

NPI: 1467612820
Provider Name (Legal Business Name): JULIO N VASQUEZ MD INC. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 RESEDA BLVD SUITE 240
NORTHRIDGE CA
91324-6142
US

IV. Provider business mailing address

8540 RESEDA BLVD SUITE 240
NORTHRIDGE CA
91324-6142
US

V. Phone/Fax

Practice location:
  • Phone: 818-772-7023
  • Fax: 818-772-7020
Mailing address:
  • Phone: 818-772-7023
  • Fax: 818-772-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA45461
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIO N VASQUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 818-772-7023