Provider Demographics
NPI:1720753213
Name:VASQUEZ, GENESIS PAMELA
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:PAMELA
Last Name:VASQUEZ
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 1:3450 3RD STREET UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:SF
Mailing Address - State:CA
Mailing Address - Zip Code:94124-5837
Mailing Address - Country:US
Mailing Address - Phone:415-437-3990
Mailing Address - Fax:
Practice Address - Street 1:3450 3RD ST STE 1C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1444
Practice Address - Country:US
Practice Address - Phone:628-224-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist