Provider Demographics
NPI:1447824719
Name:VAZQUEZ VEGA, ELISA (RD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:VAZQUEZ VEGA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:VAZQUEZ-COBUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:870 MENLO OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2354
Mailing Address - Country:US
Mailing Address - Phone:650-229-4688
Mailing Address - Fax:
Practice Address - Street 1:870 MENLO OAKS DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2354
Practice Address - Country:US
Practice Address - Phone:650-229-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86113063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered