MEDICARE: JIMMY VASQUEZ

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	106S00000X	Behavior Technician	41491092	TX

General Provider Information

NPI Number	:	1144181280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY VASQUEZ

Provider Business Mailing Address
First Line	:	1620 FM-544 E
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75287-7023
Country	:	US
Telephone Number	:	844-272-7223
Fax Number	:

Provider Business Practice Location Address
First Line	:	17671 ADDISON RD APT 402
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-7023
Country	:	US
Telephone Number	:	972-515-1097
Fax Number	:

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

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	12/03/2025

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Directions to “ JIMMY VASQUEZ ” Practice Location

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