Healthcare Provider Details

I. General information

NPI: 1750637492
Provider Name (Legal Business Name): ZENAIDA VASQUEZ-JOHNSON R.D.H. / L.P.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZENAIDA VASQUEZ R.D.H. / LPN

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date: 11/01/2012
Reactivation Date: 05/12/2014

III. Provider practice location address

650 HORTON ROAD
N. MUSKEGON MI
49445
US

IV. Provider business mailing address

650 HORTON ROAD
N. MUSKEGON MI
49445
US

V. Phone/Fax

Practice location:
  • Phone: 231-744-2387
  • Fax: 231-744-2387
Mailing address:
  • Phone: 231-744-2387
  • Fax: 231-744-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902005276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: