Healthcare Provider Details

I. General information

NPI: 1073975124
Provider Name (Legal Business Name): ROXANNE VASQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E GONZALES RD STE 140
OXNARD CA
93036-8212
US

IV. Provider business mailing address

17250 BIRCHER ST
GRANADA HILLS CA
91344-2408
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-5101
  • Fax:
Mailing address:
  • Phone: 818-368-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number152528
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA152528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: