Healthcare Provider Details

I. General information

NPI: 1033052170
Provider Name (Legal Business Name): JOLLEAN VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 ELMHURST
KYLE TX
78640-5981
US

IV. Provider business mailing address

128 KIOWA TRL
LOCKHART TX
78644-1622
US

V. Phone/Fax

Practice location:
  • Phone: 737-248-7042
  • Fax:
Mailing address:
  • Phone: 512-855-3329
  • Fax: 512-855-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: