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General NPI Number Information
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NPI Number | 1841311347
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Entity Type | Individual
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Provider Name | MARIELENA CECILIA VASQUEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 6600 VAN AALST BLVD BLDG 9250
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City | FORT BENNING
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State | GA
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Zip | 31905-2102
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Country | US
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Telephone | 624-082-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 VAN AALST BOULEVARD MARTIN ARMY COMMUNITY HOSPITAL
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City | FORT BENNING
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State | GA
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Zip | 31905
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 001912
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 62790
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License Number State | GA
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