MEDICARE: RUBEN 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	101YP2500X	Professional Counselor	72900	TX
2	101YM0800X	Mental Health Counselor	72900	TX
3	101Y00000X	Counselor	72900	TX

General Provider Information

NPI Number	:	1619338381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN VASQUEZ

Provider Business Mailing Address
First Line	:	5900 BALCONES DR STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4298
Country	:	US
Telephone Number	:	956-596-0852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 MISSION RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-1662
Country	:	US
Telephone Number	:	956-596-0852
Fax Number	:

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

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	04/02/2025

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Directions to “ RUBEN VASQUEZ ” Practice Location

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