Provider Demographics
NPI:1285460303
Name:VASQUEZ, LIONEL
Entity type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4259
Mailing Address - Country:US
Mailing Address - Phone:480-988-4645
Mailing Address - Fax:480-988-4745
Practice Address - Street 1:3336 E CHANDLER ROAD SUITE 132
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4645
Practice Address - Country:US
Practice Address - Phone:480-988-4645
Practice Address - Fax:480-988-4745
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily