Individual
GUSTAVO VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
641 CAMELIA LN, MANTECA, CA 95336-3658
(209) 640-5668
Mailing address
641 CAMELIA LN, MANTECA, CA 95336-3658
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1253454
CA
Other
Enumeration date
06/04/2026
Last updated
06/04/2026
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