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General NPI Number Information
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NPI Number | 1497206528
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Entity Type | Individual
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Provider Name | AWILDA VASQUEZ YAMBO L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 561 E 28TH ST
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City | PATERSON
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State | NJ
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Zip | 07504-1862
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Country | US
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Telephone | 201-640-5428
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Fax |
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Provider Business Mailing Address
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Address Line | 60 AUGUSTA ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-3411
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Country | US
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Telephone | 201-640-5428
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18KT00156600
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License Number State | NJ
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