Provider Demographics
NPI:1831351121
Name:VASQUEZ, PETER JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71777 SAN JACINTO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3543
Mailing Address - Country:US
Mailing Address - Phone:619-881-4574
Mailing Address - Fax:
Practice Address - Street 1:71777 SAN JACINTO DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3543
Practice Address - Country:US
Practice Address - Phone:619-881-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC195956207V00000X
PAMD441655207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology