MEDICARE: MICHELLE 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	106H00000X	Marriage & Family Therapist
2	106H00000X	Marriage & Family Therapist	122781	CA

General Provider Information

NPI Number	:	1215476189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE VAZQUEZ

Provider Business Mailing Address
First Line	:	9836 WHITEWATER RD.
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557
Country	:	US
Telephone Number	:	909-519-8665
Fax Number	:	909-833-2998

Provider Business Practice Location Address
First Line	:	2280 MARKET STREET, SUITE 145
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-0400
Country	:	US
Telephone Number	:	888-588-8995
Fax Number	:

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	05/23/2024

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Directions to “ MICHELLE VAZQUEZ ” Practice Location

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