Active NPI
Vanessa Vazquez
- Clinical Social Worker
- Gardena, CA
National Provider Identifier
1538615612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 119221
- Practice address
- 108 W Victoria St
Gardena, CA 90248 - Phone
- (310) 715-2020
- Fax
- (909) 537-7002
- NPI assigned
- Aug 29, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Community/Behavioral Health Agency | 251S00000X | P70877 | CA | |
| Clinical Social Worker | 1041C0700X | 119221 | CA | Primary |
Addresses
Primary practice location
108 W Victoria St
Gardena, CA 90248
Mailing address
108 W Victoria St
Gardena, CA 90248-3523
Phone (310) 715-2020
Other practice location 1
5500 University Pkwy
San Bernardino, CA 92407-2318
Phone (909) 537-5495
Other practice location 2
108 W Victoria St
Gardena, CA 90248
Phone (310) 715-2020
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
| License | State | Type | Specialty |
|---|---|---|---|
| P70877 | CA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726185600000",
"number": "1538615612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 W VICTORIA ST",
"city": "GARDENA",
"state": "CA",
"postal_code": "902483523",
"telephone_number": "310-715-2020",
"fax_number": "909-537-7002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 W VICTORIA ST",
"city": "GARDENA",
"state": "CA",
"postal_code": "90248",
"telephone_number": "310-715-2020",
"fax_number": "909-537-7002"
}
],
"practiceLocations": [
{
"address_1": "5500 University Pkwy",
"address_purpose": "LOCATION",
"city": "San Bernardino",
"state": "CA",
"postal_code": "924072318",
"country_code": "US",
"telephone_number": "909-537-5495",
"fax_number": "909-537-7002",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "108 W Victoria St",
"address_purpose": "LOCATION",
"city": "Gardena",
"state": "CA",
"postal_code": "90248",
"country_code": "US",
"telephone_number": "310-715-2020",
"fax_number": "909-537-7002",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAZQUEZ",
"first_name": "VANESSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-29",
"last_updated": "2024-09-13",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "CA",
"license": "P70877",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "119221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.