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General NPI Number Information
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NPI Number | 1790480960
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Entity Type | Individual
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Provider Name | JAMIL CESAR VAZQUEZ
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Gender | Male
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 8015B W SANDIA CIR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87116-5500
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Country | US
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Telephone | 779-875-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 8015B W SANDIA CIR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87116-5500
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Country | US
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Telephone | 779-875-1413
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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 | CTB-2023-0245
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License Number State | NM
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