Healthcare Provider Details

I. General information

NPI: 1538120944
Provider Name (Legal Business Name): ROBERT CLIFFORD VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RHODE ISLAND ST STE 200
SAN FRANCISCO CA
94103-5188
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-826-7575
  • Fax: 415-826-2772
Mailing address:
  • Phone: 415-826-7575
  • Fax: 415-369-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG55113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: