Provider Demographics
NPI:1174994321
Name:VAZQUEZ, CANDIDA (FNP)
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0580
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:
Practice Address - Street 1:20326 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CA
Practice Address - Zip Code:93266
Practice Address - Country:US
Practice Address - Phone:559-947-3500
Practice Address - Fax:559-947-3503
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008929363L00000X
CA662346163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse