MEDICARE: ADRIAN AVILA VASQUEZ

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	1223G0001X	General Practice Dentistry	6334251	ZZ

General Provider Information

NPI Number	:	1770333171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN AVILA VASQUEZ

Provider Business Mailing Address
First Line	:	513 DUSK VIEW ST. UNIT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79927
Country	:	US
Telephone Number	:	915-215-9491
Fax Number	:

Provider Business Practice Location Address
First Line	:	IGNACIO RAMIEREZ #227
Second Line	:
City	:	CD.JUAREZ
State	:	CHIHUAHUA
Zip	:	32300
Country	:	MX
Telephone Number	:	915-215-9491
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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Directions to “ ADRIAN AVILA VASQUEZ ” Practice Location

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