Healthcare Provider Details

I. General information

NPI: 1740601871
Provider Name (Legal Business Name): CARMEN VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 WEST AVE 4
SAN ANTONIO TX
78201-4042
US

IV. Provider business mailing address

1216 WEST AVE 4
SAN ANTONIO TX
78201-4042
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-8737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11314585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: