Individual
RENE VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14681 INDIAN WELLS DR, VICTORVILLE, CA 92394-7105
(323) 236-4976
Mailing address
14681 INDIAN WELLS DR, VICTORVILLE, CA 92394-7105
(323) 236-4976
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A9862142
CA
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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