Provider Demographics
NPI:1104406024
Name:VAZQUEZ, NORMA ALEJANDRA
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:ALEJANDRA
Last Name:VAZQUEZ
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 1:79835 PARKWAY ESPLANADE N
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8814
Mailing Address - Country:US
Mailing Address - Phone:760-702-5349
Mailing Address - Fax:
Practice Address - Street 1:49869 CALHOUN ST STE 204&205
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-9720
Practice Address - Country:US
Practice Address - Phone:760-398-9090
Practice Address - Fax:760-391-5338
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14720101YM0800X
CA140448106H00000X, 106H00000X
CAAMFT123238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health