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General NPI Number Information
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NPI Number | 1841591484
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Entity Type | Individual
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Provider Name | PHILIPPE ALEJANDRO VASQUEZ MPAS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/13/2010
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 2288 AUBURN BLVD SUTIE 106
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City | SACRAMENTO
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State | CA
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Zip | 95821-1618
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Country | US
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Telephone | 916-568-8338
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Fax | 916-925-3985
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Provider Business Mailing Address
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Address Line | 2288 AUBURN BLVD SUITE 106
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City | SACRAMENTO
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State | CA
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Zip | 95821
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Country | US
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Telephone | 916-879-0294
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21340
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License Number State | CA
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