Healthcare Provider Details

I. General information

NPI: 1629958038
Provider Name (Legal Business Name): ROSELYN HEIDI VAZQUEZ-RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 N DATE AVE APT C
RIALTO CA
92376-5961
US

IV. Provider business mailing address

158 N DATE AVE APT C
RIALTO CA
92376-5961
US

V. Phone/Fax

Practice location:
  • Phone: 909-678-2487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: