MEDICARE: CHRISTIAN ELIAS VAZQUEZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		TX

General Provider Information

NPI Number	:	1689507600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN ELIAS VAZQUEZ PHD

Provider Business Mailing Address
First Line	:	3434 LIVE OAK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 LIVE OAK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6134
Country	:	US
Telephone Number	:	805-259-6963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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