| Doctor Name: | MR. JUAN M VASQUEZ |
| NPI Number: | 1912046566 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NONE |
| License Number: | 2433 |
| Business Practice Address: | 9264 S. Wilt Bank Road Tucson, AZ - 85735 |
| Business Phone Number: | 5204400630 |
| Business Fax Number: | 5203195491 |
| Mailing Address: | 9264 S. Wilt Bank Rd., TUCSON |
| State: | AZ |
| Postal Code: | 85735 |
| Phone Number: | 5204400630 |
| Fax Number: | 5203195491 |
| NPI Enumeration Date: | 02/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | 2433 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |