Healthcare Provider Details

I. General information

NPI: 1417191032
Provider Name (Legal Business Name): KARINA VASQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 ROGERS CROSSING SUITE 210
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

7142 SAN PEDRO AVE SUITE 120
SAN ANTONIO TX
78216-6256
US

V. Phone/Fax

Practice location:
  • Phone: 210-549-3524
  • Fax: 210-549-3526
Mailing address:
  • Phone: 210-661-5622
  • Fax: 210-798-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberQ1321
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberQ1321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: