=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881968469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISABEL CRISTINA VAQUERO L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2012
-----------------------------------------------------
Last Update Date | 02/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 S BEAUDRY AVE FL 29
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-241-1259
-----------------------------------------------------
Fax | 213-241-3305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3022 CLUB RANCHO DR
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-526-6703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS28230
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------