Basic Information
| Provider Information | |||||||||
| NPI: | 1962699553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASQUEZ | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ACKERMAN RD | ||||||||
| Address2: | SUITE 570 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142932594 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1581 DODD DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142934854 | ||||||||
| FaxNumber: | 6142938102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 08/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 43493 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 35.121877 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000675457 | 01 | NIS/ANTHEM | OTHER | 000052155X | 01 | NIS/HUMANA | OTHER | 7100129940 | 05 | KY | MEDICAID | 200997810 | 05 | IN | MEDICAID | PENDING | 05 | OH | MEDICAID | 2671184 | 01 | NIS/CIGNA | OTHER | 50029914 | 01 | NIS/PHP | OTHER |