MEDICARE: MR. LUIS 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	126900000X	Dental Laboratory Technician	20181808745	CO

General Provider Information

NPI Number	:	1841010071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS VAZQUEZ

Provider Business Mailing Address
First Line	:	2034 DEVON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1618
Country	:	US
Telephone Number	:	719-354-9403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2034 DEVON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1618
Country	:	US
Telephone Number	:	719-354-9403
Fax Number	:

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

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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Directions to “ MR. LUIS VAZQUEZ ” Practice Location

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