MEDICARE: MS. FANNY 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
1	225400000X	Rehabilitation Practitioner
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1396887980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FANNY VAZQUEZ LMFT

Provider Business Mailing Address
First Line	:	4433 E VILLAGE RD
Second Line	:	STE G
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1505
Country	:	US
Telephone Number	:	626-695-0451
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 E VILLAGE RD
Second Line	:	STE G
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1505
Country	:	US
Telephone Number	:	626-695-0451
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	06/06/2011

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