MEDICARE: CHELSIE VASQUEZ

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	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07303518	OTHER		KAISER

General Provider Information

NPI Number	:	1487244232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSIE VASQUEZ

Provider Business Mailing Address
First Line	:	2412 Q ST APT 2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-6838
Country	:	US
Telephone Number	:	916-873-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 Q ST APT 2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-6838
Country	:	US
Telephone Number	:	916-873-7212
Fax Number	:

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

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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Directions to “ CHELSIE VASQUEZ ” Practice Location

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