MEDICARE: MR. CARLOS VASQUEZ PA

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	PA14141	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA14141	OTHER	CA	PA LICENSE

General Provider Information

NPI Number	:	1841479839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS VASQUEZ PA

Provider Business Mailing Address
First Line	:	4067 TWEEDY BLVD
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6146
Country	:	US
Telephone Number	:	323-569-1126
Fax Number	:	877-403-7113

Provider Business Practice Location Address
First Line	:	4067 TWEEDY BLVD
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6146
Country	:	US
Telephone Number	:	323-569-1126
Fax Number	:	877-403-7113

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	03/18/2026

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Directions to “ MR. CARLOS VASQUEZ PA” Practice Location

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