Healthcare Provider Details

I. General information

NPI: 1003688565
Provider Name (Legal Business Name): CHRISTIAN VAZQUEZ GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WINDORAH WAY APT B
WEST PALM BEACH FL
33411-1956
US

IV. Provider business mailing address

1601 WINDORAH WAY APT B
WEST PALM BEACH FL
33411-1956
US

V. Phone/Fax

Practice location:
  • Phone: 305-399-8356
  • Fax:
Mailing address:
  • Phone: 305-399-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89195
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-283884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: