MEDICARE: CARMEN 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	103K00000X	Behavior Analyst	11314585	TX

General Provider Information

NPI Number	:	1740601871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN VASQUEZ

Provider Business Mailing Address
First Line	:	1216 WEST AVE
Second Line	:	4
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-4042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 WEST AVE
Second Line	:	4
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-4042
Country	:	US
Telephone Number	:	210-680-8737
Fax Number	:

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

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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Directions to “ CARMEN VASQUEZ ” Practice Location

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