Basic Information
| Provider Information | |||||||||
| NPI: | 1609254945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASQUEZ | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CADC-CAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3170 N CHESTNUT AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592525150 | ||||||||
| FaxNumber: | 5592525156 | ||||||||
| Practice Location | |||||||||
| Address1: | 3636 N 1ST ST STE 135&154 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592251464 | ||||||||
| FaxNumber: | 8446012973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2015 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1407064843 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1082 | 05 | CA | MEDICAID |