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General NPI Number Information
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NPI Number | 1306310875
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Entity Type | Individual
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Provider Name | KURT DEAN VASQUEZ JR.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 7700 S BROADWAY
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City | LITTLETON
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State | CO
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Zip | 80122-2602
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Country | US
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Telephone | 719-334-6159
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 ROCK CREEK CIR UNIT 154
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City | SUPERIOR
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State | CO
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Zip | 80027-4615
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN.0994128-NP
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License Number State | CO
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