MEDICARE: DR. VEOLA E. VAZQUEZ PHD

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	103TC0700X	Clinical Psychologist	PSY16736	CA

General Provider Information

NPI Number	:	1720620008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VEOLA E. VAZQUEZ PHD

Provider Business Mailing Address
First Line	:	231 E ALESSANDRO BLVD # 6A918
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5084
Country	:	US
Telephone Number	:	951-215-6597
Fax Number	:	951-261-5217

Provider Business Practice Location Address
First Line	:	231 E ALESSANDRO BLVD # 6A918
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5084
Country	:	US
Telephone Number	:	951-215-6597
Fax Number	:	951-261-5217

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	01/09/2025

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