MEDICARE: LUZ 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	385HR2055X	Child Mental Illness Respite Care	2050594	AZ

General Provider Information

NPI Number	:	1902262173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ VASQUEZ

Provider Business Mailing Address
First Line	:	1929 S MAGNOLIA AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-6531
Country	:	US
Telephone Number	:	520-982-3032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1929 S MAGNOLIA AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-6531
Country	:	US
Telephone Number	:	520-982-3032
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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Directions to “ LUZ VASQUEZ ” Practice Location

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