Provider Demographics
NPI:1982986394
Name:VAZQUEZ-WHITE, ERNIE (MD)
Entity type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:
Last Name:VAZQUEZ-WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNIE
Other - Middle Name:VAZQUEZ
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:787-223-0082
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR SAN DIEGO CA 92134
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:787-223-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982986394Medicaid