Healthcare Provider Details

I. General information

NPI: 1922330554
Provider Name (Legal Business Name): NORMA VAZQUEZ DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 MADISON ST
RIVERSIDE CA
92504-2642
US

IV. Provider business mailing address

4060 MADISON ST
RIVERSIDE CA
92504-2642
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-0500
  • Fax: 951-352-0600
Mailing address:
  • Phone: 951-352-0500
  • Fax: 951-352-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number54688
License Number StateCA

VIII. Authorized Official

Name: NORMA VAZQUEZ
Title or Position: PRESIDENT
Credential: DDS
Phone: 951-352-0500