Healthcare Provider Details

I. General information

NPI: 1972595304
Provider Name (Legal Business Name): BERTHA VASQUEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N OREGON ST SUITE 800
EL PASO TX
79902-3170
US

IV. Provider business mailing address

2600 N OREGON ST SUITE 800
EL PASO TX
79902-3170
US

V. Phone/Fax

Practice location:
  • Phone: 915-534-2531
  • Fax: 915-532-2094
Mailing address:
  • Phone: 915-534-2531
  • Fax: 915-532-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number633193
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: