Provider Demographics
NPI:1013219724
Name:VASQUEZ, ROGER (LMP)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E ROWAN AVE
Mailing Address - Street 2:L2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-6007
Mailing Address - Country:US
Mailing Address - Phone:509-280-2161
Mailing Address - Fax:
Practice Address - Street 1:12 E ROWAN AVE
Practice Address - Street 2:L2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-6007
Practice Address - Country:US
Practice Address - Phone:509-280-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60034403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist