MEDICARE: ALBERTO VASQUEZ

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	172A00000X	Driver		CA

General Provider Information

NPI Number	:	1134893225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERTO VASQUEZ

Provider Business Mailing Address
First Line	:	1402 W PICO AVE STE 23
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-1377
Country	:	US
Telephone Number	:	760-556-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 W PICO AVE STE 23
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-1377
Country	:	US
Telephone Number	:	760-556-8185
Fax Number	:

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

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	05/18/2022

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Directions to “ ALBERTO VASQUEZ ” Practice Location

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