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General NPI Number Information
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NPI Number | 1144181280
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Entity Type | Individual
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Provider Name | JIMMY VASQUEZ
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Gender | Male
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 17671 ADDISON RD APT 402
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City | DALLAS
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State | TX
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Zip | 75287-7023
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Country | US
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Telephone | 972-515-1097
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 FM-544 E SUITE 100
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City | DALLAS
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State | TX
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Zip | 75287-7023
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Country | US
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Telephone | 844-272-7223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 41491092
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License Number State | TX
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