MEDICARE: ILKA E VAZQUEZ

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	RBT-23-285150	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	:	1336923069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILKA E VAZQUEZ

Provider Business Mailing Address
First Line	:	25342 SW 135TH AVE
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-6088
Country	:	US
Telephone Number	:	786-681-8956
Fax Number	:

Provider Business Practice Location Address
First Line	:	25342 SW 135TH AVE
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-6088
Country	:	US
Telephone Number	:	786-681-8956
Fax Number	:

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

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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Directions to “ ILKA E VAZQUEZ ” Practice Location

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