Active NPI
Carlos Vasquez, PA
- Physician Assistant
- South Gate, CA
National Provider Identifier
1841479839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA14141
- Practice address
- 4067 Tweedy Blvd
South Gate, CA 90280-6146 - Phone
- (323) 569-1126
- Fax
- (877) 403-7113
- NPI assigned
- Oct 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA14141 | CA | Primary |
Addresses
Primary practice location
4067 Tweedy Blvd
South Gate, CA 90280-6146
Mailing address
4067 Tweedy Blvd
South Gate, CA 90280-6146
Phone (323) 569-1126
Other practice location 1
3700 South St
Lakewood, CA 90712-1419
Phone (562) 531-2550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA14141 | Other | CA | PA LICENSE |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14141 | CA | MD | Family Nurse Practitioner |
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.
-
- Clinic/Center
- South Gate, CA
- NPI 1477100378
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773792000000",
"number": "1841479839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4067 TWEEDY BLVD",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902806146",
"telephone_number": "323-569-1126",
"fax_number": "877-403-7113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4067 TWEEDY BLVD",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902806146",
"telephone_number": "323-569-1126",
"fax_number": "877-403-7113"
}
],
"practiceLocations": [
{
"address_1": "3700 South St",
"address_purpose": "LOCATION",
"city": "Lakewood",
"state": "CA",
"postal_code": "907121419",
"country_code": "US",
"telephone_number": "562-531-2550",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VASQUEZ",
"first_name": "CARLOS",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-26",
"last_updated": "2026-03-18",
"certification_date": "2026-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA14141",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE",
"identifier": "PA14141",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Gate, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.