Healthcare Provider Details

I. General information

NPI: 1811100217
Provider Name (Legal Business Name): MARIA G VAZQUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ZARAGOZA
JUAREZ MEXICO
32550
MX

IV. Provider business mailing address

1120 WILL RAND DR
EL PASO TX
79912-7620
US

V. Phone/Fax

Practice location:
  • Phone: 526566820118
  • Fax:
Mailing address:
  • Phone: 915-449-8589
  • Fax: 915-833-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number850555
License Number StateTX

VIII. Authorized Official

Name: MARIA G. VAZQUEZ
Title or Position: OWNER
Credential: DDS
Phone: 915-449-8589