Provider Demographics
NPI:1447988357
Name:VAZQUEZ, LAWRENCE THOMAS (RN)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:THOMAS
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7833 DAY DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1097
Mailing Address - Country:US
Mailing Address - Phone:805-705-1293
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA SANTA BARBARA
Practice Address - Street 2:STUDENT HEALTH
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93117
Practice Address - Country:US
Practice Address - Phone:805-893-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373302OtherCALIFORNIA BOARD OF NURSING