Individual
MARCO VINICIO VASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15262 RIVER ROCK DR, FONTANA, CA 92336
(909) 689-5065
Mailing address
15262 RIVER ROCK DR, FONTANA, CA 92336-5344
(909) 689-5065
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
951991
CA
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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