MEDICARE: ASHLEY MARIE VASQUEZ PA-C

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1881255230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MARIE VASQUEZ PA-C

Provider Business Mailing Address
First Line	:	7314 E MILAGRO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-4965
Country	:	US
Telephone Number	:	480-201-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 E SOUTHERN AVE STE 23
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7667
Country	:	US
Telephone Number	:	623-299-8799
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	01/06/2026

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