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General NPI Number Information
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NPI Number | 1740024207
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Entity Type | Individual
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Provider Name | GENESIS VAZQUEZ SLP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | URB. BARALT I 20
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-860-4233
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Fax | 787-494-2072
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Provider Business Mailing Address
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Address Line | PO BOX 193069
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City | SAN JUAN
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State | PR
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Zip | 00919-3069
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Country | US
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Telephone | 787-761-0036
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Fax | 787-491-0286
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4608
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License Number State | PR
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