Healthcare Provider Details

I. General information

NPI: 1760905947
Provider Name (Legal Business Name): TIFFANY VAZQUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N LAKE AVE STE 800
PASADENA CA
91101-1870
US

IV. Provider business mailing address

348 SYLMAR AVE
CLOVIS CA
93612-0765
US

V. Phone/Fax

Practice location:
  • Phone: 625-449-2484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: