Healthcare Provider Details

I. General information

NPI: 1487365581
Provider Name (Legal Business Name): KARINA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 N ZARAGOZA RD
EL PASO TX
79938-8122
US

IV. Provider business mailing address

13140 BUGAMBILIA DR
SAN ELIZARIO TX
79849-8641
US

V. Phone/Fax

Practice location:
  • Phone: 915-271-8030
  • Fax:
Mailing address:
  • Phone: 915-305-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number22245874
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: