MEDICARE: VALERIA FERNANDA CARRERA VASQUEZ MS: PSYCHOLOGY

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	103K00000X	Behavior Analyst	1-24-77546	CA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1144718719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIA FERNANDA CARRERA VASQUEZ MS: PSYCHOLOGY

Provider Business Mailing Address
First Line	:	575 SCARONI AVE APT 6
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231-9702
Country	:	US
Telephone Number	:	760-562-2739
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S IMPERIAL AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3149
Country	:	US
Telephone Number	:	760-679-0540
Fax Number	:

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

Provider Enumeration Date	:	04/28/2018
Last Update Date	:	07/16/2025

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