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General NPI Number Information
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NPI Number | 1386376564
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Entity Type | Individual
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Provider Name | KIMBERLY VAZQUEZ
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 1765 GOODYEAR AVE
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City | VENTURA
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State | CA
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Zip | 93003-8025
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Country | US
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Telephone | 805-718-0104
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 596
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City | PIRU
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State | CA
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Zip | 93040-0596
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Country | US
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Telephone | 805-535-0147
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT143826
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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