Provider Demographics
NPI:1235936642
Name:VASQUEZ, MELANIE E (CHW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:VASQUEZ
Suffix:
Gender:
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15237 11TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3736
Mailing Address - Country:US
Mailing Address - Phone:760-493-9300
Mailing Address - Fax:760-493-9400
Practice Address - Street 1:15237 11TH ST STE C
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3736
Practice Address - Country:US
Practice Address - Phone:760-493-9300
Practice Address - Fax:760-493-9400
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker