Provider Demographics
NPI:1548516396
Name:VASQUEZ, BERTHA ALICIA CASTRO (DO)
Entity type:Individual
Prefix:MRS
First Name:BERTHA ALICIA
Middle Name:CASTRO
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:BERTHA
Other - Middle Name:ALICIA
Other - Last Name:CASTRO-VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:360-397-4040
Mailing Address - Fax:360-604-1770
Practice Address - Street 1:2525 NE 139TH ST STE 270
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2719
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4895207V00000X, 207VM0101X
PAOS017971207VM0101X
WAOP61275515207VM0101X, 207VM0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program