Basic Information
| Provider Information | |||||||||
| NPI: | 1598309254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASQUEZ | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3938 WEST 178TH ST | ||||||||
| Address2: | 4 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90504 | ||||||||
| CountryCode: | UM | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 AVIATION BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902784059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103762468 | ||||||||
| FaxNumber: | 3103766068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2019 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-19-99095 | CA | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.