Healthcare Provider Details

I. General information

NPI: 1336555689
Provider Name (Legal Business Name): ALIM GRICELDA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 2ND ST
SANTA MONICA CA
90401-1122
US

IV. Provider business mailing address

36 S KINNELOA AVE SUITE 100
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-6889
  • Fax: 310-394-6883
Mailing address:
  • Phone: 626-844-3033
  • Fax: 626-844-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: