Active NPI
Iridian Vazquez
- Clinical Social Worker
- Sacramento, CA
National Provider Identifier
1407405137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 811 Grand Ave Ste D
Sacramento, CA 95838-3466 - Phone
- (916) 922-9868
- NPI assigned
- Sep 5, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Social Worker | 104100000X | 109966 | CA | |
| Behavior Technician | 106S00000X | |||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
811 Grand Ave Ste D
Sacramento, CA 95838-3466
Mailing address
6400 Tupelo Dr
Citrus Heights, CA 95621-1741
Phone (916) 729-3098
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1407405137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6400 TUPELO DR",
"city": "CITRUS HEIGHTS",
"state": "CA",
"postal_code": "956211741",
"telephone_number": "916-729-3098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 GRAND AVE STE D",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958383466",
"telephone_number": "916-922-9868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAZQUEZ",
"first_name": "IRIDIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-05",
"last_updated": "2023-08-15",
"certification_date": "2023-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "109966",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.