Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A118138 | CA |
NPI | 1215204144 |
---|---|
Provider Name | Noemi Fabiola Vazquez |
First Address | Riverside, CA 92505-3043 |
Second Address | Riverside, CA 92505-3043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2011 |
Last Update Date | 06/12/2021 |