| Doctor Name: | DR. MICHAEL BERNARD VASQUEZ |
| NPI Number: | 1043485923 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 15750 |
| Business Practice Address: | 100 Prison Rd Represa, CA - 956713000 |
| Business Phone Number: | 9169858610 |
| Business Fax Number: | |
| Mailing Address: | 1424 Humbug Creek Dr, FOLSOM |
| State: | CA |
| Postal Code: | 956307641 |
| Phone Number: | 9169858610 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2008 |
| NPI Last Update Date: | 04/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 15750 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |