Provider Demographics
NPI:1548639768
Name:IVONNE VAZQUEZ DDS INC
Entity type:Organization
Organization Name:IVONNE VAZQUEZ DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-695-8711
Mailing Address - Street 1:41653 MARGARITA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3000
Mailing Address - Country:US
Mailing Address - Phone:951-695-8711
Mailing Address - Fax:
Practice Address - Street 1:41653 MARGARITA RD STE 107
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3000
Practice Address - Country:US
Practice Address - Phone:951-695-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50392261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161-908-6733OtherNPI INDIVIDUAL