Healthcare Provider Details

I. General information

NPI: 1417526815
Provider Name (Legal Business Name): BAILEY BROOK VASQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SW 30TH CT
MOORE OK
73160-2887
US

IV. Provider business mailing address

1105 SW 30TH CT
MOORE OK
73160-2887
US

V. Phone/Fax

Practice location:
  • Phone: 405-676-5114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38198
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number38198
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: