=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831043660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HIRAM I VAZQUEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2026
-----------------------------------------------------
Last Update Date | 02/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PADRE NACHO #680 CENTRO
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | SONORA
-----------------------------------------------------
Zip | 84030
-----------------------------------------------------
Country | MX
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3554 SUNSET LN UNIT 32
-----------------------------------------------------
City | SAN YSIDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92173-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-831-0437
-----------------------------------------------------
Fax | 619-785-3404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------