Provider Demographics
NPI:1447296645
Name:VASQUEZ, NORA PAULINA (MD)
Entity type:Individual
Prefix:DR
First Name:NORA
Middle Name:PAULINA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2701 OCEAN PARK BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5219
Mailing Address - Country:US
Mailing Address - Phone:310-829-8917
Mailing Address - Fax:424-212-5938
Practice Address - Street 1:2701 OCEAN PARK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5219
Practice Address - Country:US
Practice Address - Phone:310-829-8917
Practice Address - Fax:424-212-5938
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE83901Medicare UPIN
CAWG68556CMedicare PIN