Healthcare Provider Details

I. General information

NPI: 1194929513
Provider Name (Legal Business Name): ISELA VASQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7719 S IH 35 STE 212
SAN ANTONIO TX
78224-1134
US

IV. Provider business mailing address

8711 VILLAGE DR STE 114
SAN ANTONIO TX
78217-5419
US

V. Phone/Fax

Practice location:
  • Phone: 830-320-4955
  • Fax: 830-320-4956
Mailing address:
  • Phone: 210-297-2244
  • Fax: 210-297-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN6747
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: