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General NPI Number Information
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NPI Number | 1407505852
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Entity Type | Individual
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Provider Name | ELVIA MIREYA VAZQUEZ MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 205 W LEGION RD
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City | BRAWLEY
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State | CA
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Zip | 92227-7780
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Country | US
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Telephone | 760-351-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 1636 E ALAMO RD
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City | HOLTVILLE
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State | CA
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Zip | 92250-9632
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Country | US
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Telephone | 760-890-8223
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95019994
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License Number State | CA
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