Healthcare Provider Details

I. General information

NPI: 1639967003
Provider Name (Legal Business Name): ANDRE VASQUEZ PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N ROSE AVE
OXNARD CA
93036-1807
US

IV. Provider business mailing address

3100 N ROSE AVE
OXNARD CA
93036-1807
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-3119
  • Fax:
Mailing address:
  • Phone: 805-485-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number210177373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: