MEDICARE: DANIEL VASQUEZ VARGAS MASSAGE THERAPIST

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	225700000X	Massage Therapist	8331	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9144268015	OTHER		N/A

General Provider Information

NPI Number	:	1427656842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL VASQUEZ VARGAS MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	7509 COUNCIL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3253
Country	:	US
Telephone Number	:	914-426-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	7509 COUNCIL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3253
Country	:	US
Telephone Number	:	914-426-8015
Fax Number	:

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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