Provider Demographics
NPI:1487370045
Name:VASQUEZ, VIVIANA ESPERANZA
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:ESPERANZA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 DOVER PKWY
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-3440
Mailing Address - Country:US
Mailing Address - Phone:661-725-2788
Mailing Address - Fax:661-725-1957
Practice Address - Street 1:355 DOVER PKWY
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3440
Practice Address - Country:US
Practice Address - Phone:661-725-2788
Practice Address - Fax:661-725-1957
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist