Healthcare Provider Details

I. General information

NPI: 1376013672
Provider Name (Legal Business Name): DARA CHRISTINA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9364 E RAINTREE DR STE 103
SCOTTSDALE AZ
85260-2200
US

IV. Provider business mailing address

9364 E RAINTREE DR STE 103
SCOTTSDALE AZ
85260-2200
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-1124
  • Fax:
Mailing address:
  • Phone: 480-661-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013790
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: