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General NPI Number Information
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NPI Number | 1962773028
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Entity Type | Individual
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Provider Name | YENMA CONCEPCION VAZQUEZ MA 61848
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Gender | Female
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Dates
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Enumeration Date | 01/21/2012
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Last Update Date | 01/21/2012
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Provider Practice Location Address
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Address Line | 4048 EVANS AVE SUITE 208
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City | FORT MYERS
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State | FL
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Zip | 33901-9322
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Country | US
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Telephone | 239-931-4640
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Fax | 239-931-4650
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Provider Business Mailing Address
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Address Line | 4233 BELLASOL CIR APT 1811
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City | FORT MYERS
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State | FL
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Zip | 33916-7372
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Country | US
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Telephone | 239-244-4851
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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 | MA61848
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License Number State | FL
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