Healthcare Provider Details

I. General information

NPI: 1295728855
Provider Name (Legal Business Name): LUIS F. VASQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE NEUROSURGERY DEPT.
EL PASO TX
79905-2709
US

IV. Provider business mailing address

4824 ALBERTA AVE NEUROSURGERY DEPT.
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-6676
  • Fax: 915-545-7584
Mailing address:
  • Phone: 915-545-6676
  • Fax: 915-545-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG7903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: