Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 294934 | CA |
NPI | 1568938413 |
---|---|
Provider Name | Benjamin Phillip Vasquez |
First Address | San Diego, CA 92193-2410 |
Second Address | La Jolla, CA 92037-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2018 |
Last Update Date | 18/10/2018 |