MEDICARE: MR. LEO ANTHONY VASQUEZ BSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101Y00000X	Counselor	CA

General Provider Information

NPI Number	:	1194161794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEO ANTHONY VASQUEZ BSW

Provider Business Mailing Address
First Line	:	3400 WATT AVE
Second Line	:	SUITE #206
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3602
Country	:	US
Telephone Number	:	916-993-4131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 WATT AVE
Second Line	:	SUITE #206
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3602
Country	:	US
Telephone Number	:	916-821-9090
Fax Number	:

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

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	11/21/2022

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