Provider Demographics
NPI:1659128908
Name:VASQUEZ, CRISSA (PPS)
Entity type:Individual
Prefix:
First Name:CRISSA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9619 CUYAMACA ST
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2674
Mailing Address - Country:US
Mailing Address - Phone:619-258-2346
Mailing Address - Fax:
Practice Address - Street 1:9619 CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2674
Practice Address - Country:US
Practice Address - Phone:619-258-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool