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General NPI Number Information
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NPI Number | 1376220079
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Entity Type | Individual
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Provider Name | LILY DOMINQUE VASQUEZ
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 2888 LOKER AVE E STE 105
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City | CARLSBAD
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State | CA
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Zip | 92010-6683
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Country | US
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Telephone | 619-739-4569
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Fax |
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Provider Business Mailing Address
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Address Line | 575 BAKER WAY APT G
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City | OCEANSIDE
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State | CA
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Zip | 92058-7931
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Country | US
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Telephone |
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-276813
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License Number State | CA
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