Provider Demographics
NPI:1083508451
Name:VAZQUEZ, JOSE M JR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:VAZQUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 E 2ND ST # PMB87365
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2754
Mailing Address - Country:US
Mailing Address - Phone:442-271-2558
Mailing Address - Fax:
Practice Address - Street 1:375 E ROSS RD SPC 53
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9782
Practice Address - Country:US
Practice Address - Phone:442-271-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst