Basic Information
| Provider Information | |||||||||
| NPI: | 1992829915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASQUEZ-BROOKS | ||||||||
| FirstName: | ELIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4026 PECK RD | ||||||||
| Address2: | #204 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917322247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264440539 | ||||||||
| FaxNumber: | 6264447990 | ||||||||
| Practice Location | |||||||||
| Address1: | 4026 PECK RD | ||||||||
| Address2: | #204 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917322247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264440539 | ||||||||
| FaxNumber: | 6264447990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 106H00000X | IMF42895 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | VAS1113 | 01 | CA | STAFF CODE | OTHER |