Individual
MIZRAIN VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
510 NW 4TH ST, GRANTS PASS, OR 97526-2078
(541) 474-5196
(541) 474-5172
Mailing address
510 NW 4TH ST, GRANTS PASS, OR 97526-2078
(541) 474-5196
(541) 474-5172
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13-12-43
OR
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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