Healthcare Provider Details

I. General information

NPI: 1053918086
Provider Name (Legal Business Name): ARIANA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 W AZURE DR
LAS VEGAS NV
89130-4418
US

IV. Provider business mailing address

16261 MEDINAH ST
FONTANA CA
92336-5674
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 909-202-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2608
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: