Healthcare Provider Details

I. General information

NPI: 1215974241
Provider Name (Legal Business Name): ALICIA VAZQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 ALUM ROCK AVE SUITE 50
SAN JOSE CA
95127-5608
US

IV. Provider business mailing address

2820 ALUM ROCK AVE SUITE 50
SAN JOSE CA
95127-5608
US

V. Phone/Fax

Practice location:
  • Phone: 408-937-1894
  • Fax: 408-937-7819
Mailing address:
  • Phone: 408-937-1894
  • Fax: 408-937-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAO54367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: