Healthcare Provider Details

I. General information

NPI: 1740614114
Provider Name (Legal Business Name): JEFFREY EDWARD VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 WHITTIER BLVD
PICO RIVERA CA
90660-2521
US

IV. Provider business mailing address

8207 WHITTIER BLVD
PICO RIVERA CA
90660-2521
US

V. Phone/Fax

Practice location:
  • Phone: 562-965-0737
  • Fax: 562-695-0413
Mailing address:
  • Phone: 562-965-0737
  • Fax: 562-695-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: