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NPI Code Detail

MEDICARE: ILIAMARI VAZQUEZ HOUSTON LCSW

MEDICARE: ILIAMARI VAZQUEZ HOUSTON LCSW
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
11041C0700XClinical Social WorkerAZ

General Provider Information

NPI Number : 1821738634
Entity Type Code : Individual
Provider Name (Legal Business Name) : ILIAMARI VAZQUEZ HOUSTON LCSW
Provider Business Mailing Address
First Line : 4500 S LAKESHORE DR STE 415
Second Line :
City : TEMPE
State : AZ
Zip : 85282-7056
Country : US
Telephone Number : 480-234-9256
Fax Number :
Provider Business Practice Location Address
First Line : 4500 S LAKESHORE DR STE 415
Second Line :
City : TEMPE
State : AZ
Zip : 85282-7056
Country : US
Telephone Number : 480-234-9256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 01/23/2026

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