Healthcare Provider Details

I. General information

NPI: 1225547078
Provider Name (Legal Business Name): KIRSY PUPO VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 116
DORAL FL
33122-1075
US

IV. Provider business mailing address

9501 FONTAINEBLEAU BLVD APT 608
MIAMI FL
33172-6822
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-7898
  • Fax:
Mailing address:
  • Phone: 786-413-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: