Healthcare Provider Details

I. General information

NPI: 1194648378
Provider Name (Legal Business Name): ELIZABETH MIXTITLAN VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N HALL ST
VISALIA CA
93291-4639
US

IV. Provider business mailing address

3206 E SAGINAW WAY
FRESNO CA
93726-4420
US

V. Phone/Fax

Practice location:
  • Phone: 559-667-7387
  • Fax:
Mailing address:
  • Phone: 559-360-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: