Individual provider Active NPI

Katherine Elizabeth Vazquez, PA-C

  • Physician Assistant
  • Rialto, CA
National Provider Identifier
1023654530
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1850 N Riverside Ave Ste 180
Rialto, CA 92376-8071
Phone
(909) 787-1987
NPI assigned
Nov 19, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1850 N Riverside Ave Ste 180
Rialto, CA 92376-8071

Mailing address

1850 N Riverside Ave Ste 180
Rialto, CA 92376-8071
Phone (097) 871-9879

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260127001410 CA Practitioner - Physician Assistant 6901383439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1850 N Riverside Ave
Suite 180
Rialto, CA 92376-8071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
64848CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
The Maven Group Inc. CurrentSince Dec 15, 2025 Accepting new patients

Locations

1850 N Riverside Ave
Ste 180
Rialto, CA 92376
Phone (909) 562-0255

3380 La Sierra Ave
Riverside, CA 92503
Phone (951) 354-9999

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AACGCD/Endpoint/AACGCD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1023654530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 N RIVERSIDE AVE STE 180",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923768071",
            "telephone_number": "097-871-9879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N RIVERSIDE AVE STE 180",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923768071",
            "telephone_number": "909-787-1987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZQUEZ",
        "first_name": "KATHERINE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rialto, CA

Sources for this page

Verify at the official NPI Registry.