Healthcare Provider Details

I. General information

NPI: 1235182908
Provider Name (Legal Business Name): JOSEFA VAZQUEZ-RENTAS RD,CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JOSEFA VAZQUEZ RD,CDN

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 85TH ST APT B40
BROOKLYN NY
11209-4863
US

IV. Provider business mailing address

565 85TH ST APT B40
BROOKLYN NY
11209-4863
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax:
Mailing address:
  • Phone: 718-836-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number48004097
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: