Provider Demographics
NPI:1407692106
Name:VAZQUEZ, BRIAN DANIEL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DANIEL
Last Name:VAZQUEZ
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 1:434 D ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5357
Mailing Address - Country:US
Mailing Address - Phone:213-265-1800
Mailing Address - Fax:
Practice Address - Street 1:434 D ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5357
Practice Address - Country:US
Practice Address - Phone:213-265-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician