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NPI Code Detail

MEDICARE: LORI J VASQUEZ

MEDICARE: LORI J 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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1902065576
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI J VASQUEZ
Provider Business Mailing Address
First Line : 738 MAIN ST UNIT 302
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-3045
Country : US
Telephone Number : 562-988-3436
Fax Number :
Provider Business Practice Location Address
First Line : 3505 LONG BEACH BLVD STE 1F
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-3946
Country : US
Telephone Number : 562-988-3436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2008
Last Update Date : 06/08/2008

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Directions to “ LORI J VASQUEZ ” Practice Location

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