Healthcare Provider Details

I. General information

NPI: 1548639768
Provider Name (Legal Business Name): IVONNE VAZQUEZ DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41653 MARGARITA RD STE 107
TEMECULA CA
92591-3000
US

IV. Provider business mailing address

41653 MARGARITA RD STE 107
TEMECULA CA
92591-3000
US

V. Phone/Fax

Practice location:
  • Phone: 951-695-8711
  • Fax:
Mailing address:
  • Phone: 951-695-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number50392
License Number StateCA

VIII. Authorized Official

Name: DR. IVONNE VAZQUEZ
Title or Position: DENTIST
Credential: DDS
Phone: 951-695-8711