Provider Demographics
NPI:1871051185
Name:VASQUEZ RAMIREZ, JULISSA NAYELI
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:NAYELI
Last Name:VASQUEZ RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 ARLINGTON BLVD APT 45
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2662
Mailing Address - Country:US
Mailing Address - Phone:559-356-2124
Mailing Address - Fax:
Practice Address - Street 1:1333 ARLINGTON BLVD APT 45
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2662
Practice Address - Country:US
Practice Address - Phone:559-356-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician