MEDICARE: LAURA 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	374700000X	Technician

General Provider Information

NPI Number	:	1295577823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA VASQUEZ

Provider Business Mailing Address
First Line	:	961 SW 80TH AVE APT B
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3206
Country	:	US
Telephone Number	:	754-242-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	961 SW 80TH AVE APT B
Second Line	:
City	:	N LAUDERDALE
State	:	FL
Zip	:	33068-3206
Country	:	US
Telephone Number	:	754-242-5551
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/12/2024

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Directions to “ LAURA VASQUEZ ” Practice Location

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