Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A126312 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | A126312 | CA |
NPI | 1003104548 |
---|---|
Provider Name | Cathia Vazquez |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Marina Del Rey, CA 90292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 07/10/2019 |