=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932352804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERTO L VAZQUEZ PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2008
-----------------------------------------------------
Last Update Date | 10/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 257 S FAIR OAKS AVE SUITE 100
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-449-0099
-----------------------------------------------------
Fax | 626-449-7666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 579 HARGRAVE ST
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-677-0168
-----------------------------------------------------
Fax | 310-677-0168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH29680
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------