Healthcare Provider Details

I. General information

NPI: 1912248527
Provider Name (Legal Business Name): VAQUERO MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 NOYCE RD
CROSBY TX
77532-7807
US

IV. Provider business mailing address

PO BOX 204249
DALLAS TX
75320-4249
US

V. Phone/Fax

Practice location:
  • Phone: 281-346-3480
  • Fax: 832-581-4677
Mailing address:
  • Phone: 281-346-3480
  • Fax: 832-581-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF KROPHOLLER
Title or Position: DIRECTOR
Credential:
Phone: 254-221-2900