Healthcare Provider Details

I. General information

NPI: 1396369385
Provider Name (Legal Business Name): CHRISTINE VAZQUEZ DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE CAMBEL

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 BALBOA AVE RM 70
SAN DIEGO CA
92111-3447
US

IV. Provider business mailing address

9133 SYCAMORE LEAF DR
FORT WORTH TX
76179-5231
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-8232
  • Fax: 858-496-8234
Mailing address:
  • Phone: 430-558-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1104220
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015590
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95067577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: