Individual
CLARISSA GUADALUPE VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
382 RED CEDAR PL, PERRIS, CA 92570-2537
(951) 570-2365
Mailing address
382 RED CEDAR PL, PERRIS, CA 92570-2537
(951) 570-2365
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20020600563900
IEHP DIRECT
—
Enumeration date
08/22/2019
Last updated
08/22/2019
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