MEDICARE: DR. JESUS VAZQUEZ M.D.

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	207R00000X	Internal Medicine Physician	248555-1	NY
2	207R00000X	Internal Medicine Physician	224687	MA
3	207RC0000X	Cardiovascular Disease Physician	A121093	CA
4	207RC0001X	Clinical Cardiac Electrophysiology Physician	A121093	CA

General Provider Information

NPI Number	:	1891841144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS VAZQUEZ M.D.

Provider Business Mailing Address
First Line	:	235 E BADILLO ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2116
Country	:	US
Telephone Number	:	626-793-2885
Fax Number	:	626-793-6262

Provider Business Practice Location Address
First Line	:	289 W HUNTINGTON DR STE 401
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-3493
Country	:	US
Telephone Number	:	626-254-0074
Fax Number	:	626-254-0079

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/26/2024

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