MEDICARE: CHRISTIAN VAZQUEZ GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-89195	FL
2	106S00000X	Behavior Technician	RBT-23-283884	FL

General Provider Information

NPI Number	:	1003688565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN VAZQUEZ GARCIA

Provider Business Mailing Address
First Line	:	1601 WINDORAH WAY APT B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-1956
Country	:	US
Telephone Number	:	305-399-8356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 WINDORAH WAY APT B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-1956
Country	:	US
Telephone Number	:	305-399-8356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	04/20/2026

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