MEDICARE: EMMA 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1790677235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA VASQUEZ

Provider Business Mailing Address
First Line	:	2001 W MICHIGAN ST APT 401
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1925
Country	:	US
Telephone Number	:	779-279-4509
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 E MORELAND BLVD
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-2939
Country	:	US
Telephone Number	:	779-279-4509
Fax Number	:

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

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	01/25/2026

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Directions to “ EMMA VASQUEZ ” Practice Location

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