Individual
KATIE LYNN VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 955-7163
Mailing address
1260 W BLAINE ST APT 13, RIVERSIDE, CA 92507-3699
(951) 452-2544
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
CA
175T00000X
Peer Specialist
Primary
BKITYVZOJMUFESPN
CA
Other
Enumeration date
08/24/2022
Last updated
07/05/2023
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