Healthcare Provider Details

I. General information

NPI: 1700528403
Provider Name (Legal Business Name): MOISES ABRAHAM VASQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date: 01/03/2023
Reactivation Date: 11/03/2023

III. Provider practice location address

110 IRVING ST NW # DC20010
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW # DC20010
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7000
  • Fax:
Mailing address:
  • Phone: 202-877-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: