Active NPI
Juan M Vasquez, NONE
- Mental Illness Community Based Residential Treatment Facility
- Tucson, AZ
National Provider Identifier
1912046566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- 2433
- Practice address
- 9264 S. Wilt Bank Road
Tucson, AZ 85735 - Phone
- (520) 440-0630
- Fax
- (520) 319-5491
- NPI assigned
- Feb 6, 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 |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 2433 | AZ | Primary |
Addresses
Primary practice location
9264 S. Wilt Bank Road
Tucson, AZ 85735
Mailing address
9264 S. Wilt Bank Rd.
Tucson, AZ 85735
Phone (520) 440-0630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2433 | Other | AZ | BEHAVIORAL HEALTH NUMBER |
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 |
|---|---|---|---|
| 2433 | AZ | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912046566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9264 S. WILT BANK RD.",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85735",
"telephone_number": "520-440-0630",
"fax_number": "520-319-5491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9264 S. WILT BANK ROAD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85735",
"telephone_number": "520-440-0630",
"fax_number": "520-319-5491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASQUEZ",
"first_name": "JUAN",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "NONE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "AZ",
"license": "2433",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIORAL HEALTH NUMBER",
"identifier": "2433",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.