MEDICARE: GLADIS 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	1041C0700X	Clinical Social Worker	106601	TX

General Provider Information

NPI Number	:	1326900044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADIS VASQUEZ

Provider Business Mailing Address
First Line	:	2113 E MAIN ST
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-6140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 E MAIN ST
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-6140
Country	:	US
Telephone Number	:	703-850-6413
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ GLADIS VASQUEZ ” Practice Location

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