Individual
ISAIAH DARIAN VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDA
Contact information
Practice address
9910 LONG BEACH BLVD STE A, LYNWOOD, CA 90262-1561
(323) 538-2002
Mailing address
8020 BIRCHCREST RD APT E104, DOWNEY, CA 90240-2107
(562) 565-7479
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
93763
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93763
—
CA
Enumeration date
11/25/2019
Last updated
11/25/2019
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