Provider Demographics
NPI:1528068483
Name:VASQUEZ, FABIO (MD)
Entity type:Individual
Prefix:
First Name:FABIO
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 S EL CAMINO REAL STE 315
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6390
Mailing Address - Country:US
Mailing Address - Phone:206-218-7850
Mailing Address - Fax:
Practice Address - Street 1:2204 S EL CAMINO REAL STE 315
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6390
Practice Address - Country:US
Practice Address - Phone:206-218-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41543207Q00000X
AZ35174207Q00000X
WAMD60158774207Q00000X
FLME142744207Q00000X
CAC193582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528068483Medicaid
WA266404OtherLABOR & INDUSTRIES
G8896307Medicare PIN
WA266404OtherLABOR & INDUSTRIES
WA1528068483Medicaid
G8893518Medicare PIN
MNG88821Medicare UPIN
G8899469Medicare PIN