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NPI Code Detail

MEDICARE: JORGE VACA JR.

MEDICARE: JORGE VACA JR.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1265999304
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE VACA JR.
Provider Business Mailing Address
First Line : 9140 VAN NUYS BLVD
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-6727
Country : US
Telephone Number : 818-895-2206
Fax Number : 818-895-0824
Provider Business Practice Location Address
First Line : 9140 VAN NUYS BLVD
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-6727
Country : US
Telephone Number : 818-895-2006
Fax Number : 818-895-0824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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