Individual
KIMBERLY NICOLE VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1049 E 21ST ST, LOS ANGELES, CA 90011-1115
(323) 443-5183
Mailing address
1049 E 21ST ST, LOS ANGELES, CA 90011-1115
(323) 443-5183
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y9227721
MEDICAL
CA
Enumeration date
11/22/2021
Last updated
11/22/2021
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