MEDICARE: CLARA VAZQUEZ

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	225700000X	Massage Therapist	76825	CA

General Provider Information

NPI Number	:	1114526563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA VAZQUEZ

Provider Business Mailing Address
First Line	:	1745 N ORANGE DR APT 207
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4338
Country	:	US
Telephone Number	:	917-832-5799
Fax Number	:

Provider Business Practice Location Address
First Line	:	3329 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2117
Country	:	US
Telephone Number	:	323-922-6007
Fax Number	:

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

Provider Enumeration Date	:	10/17/2020
Last Update Date	:	10/17/2020

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Directions to “ CLARA VAZQUEZ ” Practice Location

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