Healthcare Provider Details

I. General information

NPI: 1083745491
Provider Name (Legal Business Name): JULIO E VAQUERANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

PO BOX 577680
MODESTO CA
95357-7680
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax: 209-735-4374
Mailing address:
  • Phone: 209-735-5000
  • Fax: 209-735-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA65735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: