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General NPI Number Information
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NPI Number | 1114396165
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Entity Type | Organization
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Legal Business Name | BERNICE VAZQUEZ, PSY.D.; LLC
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 5728 MAJOR BLVD STE 222
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City | ORLANDO
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State | FL
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Zip | 32819-7969
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Country | US
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Telephone | 321-430-7017
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Fax |
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Provider Business Mailing Address
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Address Line | 5728 MAJOR BLVD STE 222
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City | ORLANDO
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State | FL
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Zip | 32819-7969
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Country | US
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Telephone | 321-430-7017
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BERNICE VAZQUEZ GARAY
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Credential | PSY.D.
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Telephone | 321-430-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9271
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License Number State | FL
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