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General NPI Number Information
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NPI Number | 1215376587
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Entity Type | Individual
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Provider Name | CARLOS A VASQUEZ FNP
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Gender | Male
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 6248 S CLERNATES DR
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City | WEST JORDAN
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State | UT
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Zip | 84081-3831
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Country | US
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Telephone | 480-282-3358
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Fax | 801-955-6173
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Provider Business Mailing Address
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Address Line | 6248 S CLERNATES DR
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City | WEST JORDAN
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State | UT
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Zip | 84081-3831
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Country | US
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Telephone | 480-282-3358
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Fax | 801-955-6173
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6261157-8900
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License Number State | UT
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