Healthcare Provider Details

I. General information

NPI: 1700419959
Provider Name (Legal Business Name): MRS. ALICIA NICOLE VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3040
US

IV. Provider business mailing address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3040
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax: 619-330-2760
Mailing address:
  • Phone: 619-383-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: