Healthcare Provider Details

I. General information

NPI: 1477462273
Provider Name (Legal Business Name): LESLIE VASQUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

114 S ROOSEVELT AVE APT D
OXNARD CA
93030-6045
US

V. Phone/Fax

Practice location:
  • Phone: 805-364-8521
  • Fax:
Mailing address:
  • Phone: 805-775-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: