MEDICARE: EDNA LIZBETH 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	363LP0200X	Pediatric Nurse Practitioner	AP130204	TX

General Provider Information

NPI Number	:	1508224643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA LIZBETH VAZQUEZ

Provider Business Mailing Address
First Line	:	1390 GEORGE DIETER DR STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7423
Country	:	US
Telephone Number	:	915-591-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1390 GEORGE DIETER DR STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7423
Country	:	US
Telephone Number	:	915-591-7704
Fax Number	:

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

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	02/03/2016

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