Healthcare Provider Details

I. General information

NPI: 1174448039
Provider Name (Legal Business Name): WENDY LEE VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR
OXNARD CA
93036-0617
US

IV. Provider business mailing address

13122 WESTPORT ST
MOORPARK CA
93021-2958
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4200
  • Fax:
Mailing address:
  • Phone: 310-874-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: