Healthcare Provider Details

I. General information

NPI: 1275455669
Provider Name (Legal Business Name): ANNEL YULEYDI VASQUEZ JAVIER
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ANNEL YULEYDI VASQUEZ JAVIER

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9816 WOODBERRY ST
LANHAM MD
20706-3659
US

IV. Provider business mailing address

9816 WOODBERRY ST
LANHAM MD
20706-3659
US

V. Phone/Fax

Practice location:
  • Phone: 202-361-6099
  • Fax:
Mailing address:
  • Phone: 202-361-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: