Healthcare Provider Details

I. General information

NPI: 1376772202
Provider Name (Legal Business Name): JAZMIN VASQUEZ MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAZMIN VAZQUEZ

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 AVENUE 64
PASADENA CA
91105
US

IV. Provider business mailing address

940 AVENUE 64
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-2274
  • Fax: 323-254-9087
Mailing address:
  • Phone: 323-254-2274
  • Fax: 323-254-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF62763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: