Basic Information
| Provider Information | |||||||||
| NPI: | 1093996530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASQUEZ | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BC-HIS | ||||||||
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| OtherLastName: | VAZQUEZ | ||||||||
| OtherFirstName: | KATHY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10570 SE WASHINGTON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032576800 | ||||||||
| FaxNumber: | 5032576810 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 E LATHAM | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519259948 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 04/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 3397 | CA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HA 3397 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.