MEDICARE: MR. FERNANDO VASQUEZ JR.

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	363A00000X	Physician Assistant	PA11933	TX

General Provider Information

NPI Number	:	1144719428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FERNANDO VASQUEZ JR.

Provider Business Mailing Address
First Line	:	24403 PENNSYLVANIA AVE
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-6875
Country	:	US
Telephone Number	:	956-367-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 N ED CAREY DR STE A
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8281
Country	:	US
Telephone Number	:	956-205-1244
Fax Number	:	956-205-1245

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

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	04/16/2022

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