Provider Demographics
NPI:1538717194
Name:VASQUEZ, JOE LUIS II
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:LUIS
Last Name:VASQUEZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 RAINIER AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-1912
Mailing Address - Country:US
Mailing Address - Phone:206-678-7062
Mailing Address - Fax:206-325-6516
Practice Address - Street 1:502 RAINIER AVE S STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-1912
Practice Address - Country:US
Practice Address - Phone:206-678-7062
Practice Address - Fax:206-325-6516
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61083737104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker