Healthcare Provider Details

I. General information

NPI: 1770084980
Provider Name (Legal Business Name): MARIA GUADALUPE VAZQUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

1114 CORTEZ ST UNIT B
SALINAS CA
93905-1898
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-8250
  • Fax:
Mailing address:
  • Phone: 831-269-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: