MEDICARE: RITA ANGELA VASQUEZ RN, BSN, IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	618652	TX

General Provider Information

NPI Number	:	1356847925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA ANGELA VASQUEZ RN, BSN, IBCLC

Provider Business Mailing Address
First Line	:	2017 BROADWAY ST STE B
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-5501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 HIALEAH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-5638
Country	:	US
Telephone Number	:	713-208-6695
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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