Healthcare Provider Details

I. General information

NPI: 1245687870
Provider Name (Legal Business Name): JOSE A VAZQUEZ BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSE ABEL VAZQUEZ VIQUILLON BCABA

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14325 SW 164TH TER
MIAMI FL
33177-1866
US

IV. Provider business mailing address

14325 SW 164TH TER
MIAMI FL
33177-1866
US

V. Phone/Fax

Practice location:
  • Phone: 786-541-3008
  • Fax:
Mailing address:
  • Phone: 786-541-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-10493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: