Basic Information
| Provider Information | |||||||||
| NPI: | 1497739908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COAKER | ||||||||
| FirstName: | CECILE | ||||||||
| MiddleName: | VASQUEZ | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | VASQUEZ | ||||||||
| OtherFirstName: | CECILE | ||||||||
| OtherMiddleName: | SAMSON | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2000 GARDEN RD | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313751885 | ||||||||
| FaxNumber: | 8313757436 | ||||||||
| Practice Location | |||||||||
| Address1: | 2230 GLADSTONE DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254275155 | ||||||||
| FaxNumber: | 9254279552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT28243 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0PT282431 | 01 | CA | MEDICARE PTAN | OTHER |