MEDICARE: ISABEL C VAZQUEZ-RIVERA

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

General Provider Information

NPI Number	:	1154829364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL C VAZQUEZ-RIVERA

Provider Business Mailing Address
First Line	:	1200 E STAN SCHLUETER LOOP STE 107
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-5482
Country	:	US
Telephone Number	:	254-251-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E STAN SCHLUETER LOOP
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-5481
Country	:	US
Telephone Number	:	254-251-5843
Fax Number	:

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

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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