Provider Demographics
NPI:1174107189
Name:VAZQUEZ, PATRICIA DENISE (COTA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DENISE
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 OCEANSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2786
Mailing Address - Country:US
Mailing Address - Phone:510-755-8239
Mailing Address - Fax:
Practice Address - Street 1:2900 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8310
Practice Address - Country:US
Practice Address - Phone:925-201-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant