Healthcare Provider Details

I. General information

NPI: 1861184756
Provider Name (Legal Business Name): EVELYN MARICRUZ VASQUEZ ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYN MARICRUZ RIOS

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 GISH CAMPUS
SAN JOSE CA
95112
US

IV. Provider business mailing address

232 E GISH RD
SAN JOSE CA
95112-4706
US

V. Phone/Fax

Practice location:
  • Phone: 669-225-0212
  • Fax:
Mailing address:
  • Phone: 669-225-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number127915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: