MEDICARE: GRETHEL 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-21-55470	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275033466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETHEL VAZQUEZ GARCIA

Provider Business Mailing Address
First Line	:	8670 NW 16TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-4828
Country	:	US
Telephone Number	:	786-731-9878
Fax Number	:

Provider Business Practice Location Address
First Line	:	7971 RIVIERA BLVD STE 323
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6448
Country	:	US
Telephone Number	:	954-893-7300
Fax Number	:

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

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	03/18/2026

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