Individual
MICHELE RENE VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8432 MAGNOLIA AVE, RIVERSIDE, CA 92504-3206
(951) 343-4317
Mailing address
8432 MAGNOLIA AVE, RIVERSIDE, CA 92504-3297
(951) 343-4317
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C2564777
—
CA
Enumeration date
09/20/2019
Last updated
09/20/2019
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