Basic Information
| Provider Information | |||||||||
| NPI: | 1942453907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURCIA-VASQUEZ | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5643 E WAVERLY LN | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937275437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594337517 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 83 E SHAW AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937107620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592260167 | ||||||||
| FaxNumber: | 5592261559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2008 | ||||||||
| LastUpdateDate: | 04/08/2010 | ||||||||
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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 | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 18809 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.