Healthcare Provider Details

I. General information

NPI: 1932736436
Provider Name (Legal Business Name): CLAUDIA ANNET VAZQUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HAMPTON DR
VENICE CA
90291-8633
US

IV. Provider business mailing address

204 HAMPTON DR
VENICE CA
90291-8633
US

V. Phone/Fax

Practice location:
  • Phone: 310-427-5602
  • Fax:
Mailing address:
  • Phone: 310-427-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94527
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: