Healthcare Provider Details

I. General information

NPI: 1215330139
Provider Name (Legal Business Name): DAVID MARK VASQUEZ HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 GEARY BLVD
SAN FRANCISCO CA
94118-2816
US

IV. Provider business mailing address

5138 GEARY BLVD
SAN FRANCISCO CA
94118-2816
US

V. Phone/Fax

Practice location:
  • Phone: 415-824-6865
  • Fax:
Mailing address:
  • Phone: 415-824-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA1042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: