Individual provider Active NPI

Manuel John Vasquez

  • Addiction (Substance Use Disorder) Counselor
  • Fresno, CA
National Provider Identifier
1164136115
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
17186 Issued in CA
Practice address
2772 S Martin Luther King Jr Blvd
Fresno, CA 93706-5345
Phone
(559) 265-4800
NPI assigned
Jan 12, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 17186 CA Primary

Addresses

Primary practice location

2772 S Martin Luther King Jr Blvd
Fresno, CA 93706-5345

Mailing address

2772 S. Martin Luther King BVLD
2772 S. Martin Luther King BVLD
Fresno, CA 93706-3056
Phone (559) 265-4800

Other practice location 1

3333 E American Ave
Fresno, CA 93725-9247
Phone (559) 600-7644

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
17186CAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1164136115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2772 S. MARTIN LUTHER KING BVLD",
            "address_2": "2772 S. MARTIN LUTHER KING BVLD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937063056",
            "telephone_number": "559-265-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2772 S MARTIN LUTHER KING JR BLVD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937065345",
            "telephone_number": "559-265-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 E American Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937259247",
            "country_code": "US",
            "telephone_number": "559-600-7644",
            "fax_number": "559-600-4869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "MANUEL",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-12",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "17186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.