NPIMap

Individual provider Active NPI

Noemi Vazquez, M.D.

  • Family Medicine Physician
  • Alpine, CA
National Provider Identifier
1174604680
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C53229 Issued in CA
Practice address
4058 Willows Rd
Alpine, CA 91901-1668
Phone
(619) 445-1188
Fax
(619) 659-3140
NPI assigned
Oct 18, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K7932 TX
Family Medicine Physician 207Q00000X C53229 CA Primary

Addresses

Primary practice location

4058 Willows Rd
Alpine, CA 91901-1668

Mailing address

200 Oceangate
Suite 100
Long Beach, CA 90802-4317
Phone (562) 499-6191

Other practice location 1

887 E. Second Street
Pomona, CA 91766-2009
Phone (909) 620-7769

Other practice location 2

36350 Church Rd
Campo, CA 91906-2715
Phone (619) 445-1188 ext. 700

Other identifiers 1

IdentifierTypeStateIssuer
C53229OtherCACA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040510001202 TX Practitioner - Family Practice 3870582380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas a & M University System, HSC, College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Physicians Specialty ServicesGroup PAC ID 2567544570, 83 clinicians

Practice addresses (Care Compare)

11452 Space Ctr Blvd
Houston, TX 77059-3599
Phone (713) 486-6200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C53229CAMDFamily Medicine Physician
K7932TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians Family Medicine Past Accepting new patients
Santa Clara Health Center PastSince Jan 19, 2012 Accepting new patients
Molina Healthcare of California Family Medicine Past Accepting new patients
Molina Medical Centers Family Medicine Past Accepting new patients
Molina Healthcare of California Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: nvazquez478697@directhoustonmethodist.org

Organizations & group practices 6

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1174604680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE",
            "address_2": "SUITE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "562-499-6191",
            "fax_number": "562-499-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4058 WILLOWS RD",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011668",
            "telephone_number": "619-445-1188",
            "fax_number": "619-659-3140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "887 E. Second Street",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917662009",
            "country_code": "US",
            "telephone_number": "909-620-7769",
            "fax_number": "909-469-1997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36350 Church Rd",
            "address_purpose": "LOCATION",
            "city": "Campo",
            "state": "CA",
            "postal_code": "919062715",
            "country_code": "US",
            "telephone_number": "619-445-1188 x700",
            "fax_number": "619-659-3140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAZQUEZ",
        "first_name": "NOEMI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K7932",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C53229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "C53229",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpine, CA

Sources for this page

Verify at the official NPI Registry.