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General NPI Number Information
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NPI Number | 1588207203
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Entity Type | Individual
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Provider Name | JACQUELIN MARLENE VAZQUEZ MSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 711 E BALL RD
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City | ANAHEIM
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State | CA
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Zip | 92805-5930
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Country | US
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Telephone | 657-276-4187
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Fax |
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Provider Business Mailing Address
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Address Line | 7851 ORANGEWOOD AVE
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City | STANTON
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State | CA
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Zip | 90680-3511
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Country | US
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Telephone | 626-675-8344
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 89288
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License Number State | CA
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