Individual
ERNESTO VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1144 GATEWAY LOOP STE 200, SPRINGFIELD, OR 97477-7706
(541) 279-4651
Mailing address
2555 ROOSEVELT BLVD APT 5, EUGENE, OR 97402-2549
(541) 279-4651
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
OR
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/29/2022
Last updated
11/13/2023
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