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General NPI Number Information
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NPI Number | 1275033466
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Entity Type | Individual
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Provider Name | GRETHEL VAZQUEZ GARCIA
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 10200 NW 25TH ST STE 204
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City | DORAL
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State | FL
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Zip | 33172-5922
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Country | US
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Telephone | 305-406-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 6575 W 4TH AVE APT 506
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City | HIALEAH
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State | FL
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Zip | 33012-6658
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Country | US
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Telephone | 786-731-9878
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-55470
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License Number State | FL
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