Doctor Name: | MACARIO RUIZ VAZQUEZ |
NPI Number: | 1689747032 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | A42097 |
Business Practice Address: | 19881 Hwy 88 Ste #5 Pine Grove, CA - 95665 |
Business Phone Number: | 2092966811 |
Business Fax Number: | 2092966827 |
Mailing Address: | Po Box 1539, PINE GROVE |
State: | CA |
Postal Code: | 95665 |
Phone Number: | 2092966811 |
Fax Number: | 2092966827 |
NPI Enumeration Date: | 11/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A42097 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |