Provider Demographics
NPI:1386268399
Name:VASQUEZ, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
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 1:120 DOOL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-5067
Mailing Address - Country:US
Mailing Address - Phone:442-225-1450
Mailing Address - Fax:
Practice Address - Street 1:120 DOOL AVE APT 3
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-5067
Practice Address - Country:US
Practice Address - Phone:442-225-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician