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1750353892 NPI number — RICKY S ONOFRE-VASQUEZ M.D.

NPI Number: 1750353892
Health Care Provider/Practitioner: RICKY S ONOFRE-VASQUEZ M.D.

Information about “1750353892” NPI (RICKY S ONOFRE-VASQUEZ M.D.) exists in 1750353892 in HTML format HTML  |  1750353892 in plain Text format TXT  |  1750353892 in PDF (Portable Document Format) PDF  |  1750353892 in an XML format XML  formats.

NPI Number : 1750353892 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750353892",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ONOFRE-VASQUEZ",
    "FirstName": "RICKY",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16661 AKRON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PACIFIC PALISADES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90272-2308",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-454-6948",
    "MailingAddressFaxNumber": "310-454-6948",
    "FirstLinePracticeLocationAddress": "12099 W WASHINGTON BLVD STE 202",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90066-5882",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-572-6225",
    "PracticeLocationAddressFaxNumber": "310-572-1267",
    "EnumerationDate": "02/03/2006",
    "LastUpdateDate": "11/16/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "AO48136",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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