Healthcare Provider Details

I. General information

NPI: 1861322471
Provider Name (Legal Business Name): RAPHAEL L VAZQUEZ APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E WOODFIELD RD STE 330
SCHAUMBURG IL
60173-5128
US

IV. Provider business mailing address

1701 E WOODFIELD RD STE 330
SCHAUMBURG IL
60173-5128
US

V. Phone/Fax

Practice location:
  • Phone: 847-592-5588
  • Fax:
Mailing address:
  • Phone: 847-592-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209035133
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: