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General NPI Number Information
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NPI Number | 1891471777
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Entity Type | Individual
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Provider Name | TIFFANY DYONNE VASQUEZ SUDRC 15344
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 2850 N TRACY BLVD STE 201
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City | TRACY
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State | CA
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Zip | 95376-7767
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Country | US
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Telephone | 855-223-7123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33568
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City | SAN DIEGO
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State | CA
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Zip | 92163-3568
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Country | US
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Telephone | 855-223-7123
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SUDRC-15344
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 39007BN
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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