MEDICARE: DAMIAN VAQUERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist		CA

General Provider Information

NPI Number	:	1093596769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMIAN VAQUERA

Provider Business Mailing Address
First Line	:	1650 EXPLORATION FALLS DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1961
Country	:	US
Telephone Number	:	619-591-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 EXPLORATION FALLS DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1961
Country	:	US
Telephone Number	:	619-591-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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Directions to “ DAMIAN VAQUERA ” Practice Location

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