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NPI Code Detail

MEDICARE: JONATHAN JULIAN VAZQUEZ LMFT

MEDICARE: JONATHAN JULIAN VAZQUEZ LMFT
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
1106H00000XMarriage & Family TherapistLMFT161681CA

General Provider Information

NPI Number : 1265161921
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN JULIAN VAZQUEZ LMFT
Provider Business Mailing Address
First Line : 919 LOTUS CIR
Second Line :
City : SAN DIMAS
State : CA
Zip : 91773-1559
Country : US
Telephone Number : 619-786-0338
Fax Number :
Provider Business Practice Location Address
First Line : 150 E MEDA AVE STE 110
Second Line :
City : GLENDORA
State : CA
Zip : 91741-2607
Country : US
Telephone Number : 619-786-0338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2022
Last Update Date : 03/23/2026

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Directions to “ JONATHAN JULIAN VAZQUEZ LMFT” Practice Location

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