Provider Demographics
NPI:1013575208
Name:VAZQUEZ, GABRIELLA YVETTE
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:YVETTE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BRIGHTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23690-3517
Mailing Address - Country:US
Mailing Address - Phone:757-812-1085
Mailing Address - Fax:
Practice Address - Street 1:12318 BOYDTON PLANK RD
Practice Address - Street 2:
Practice Address - City:DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23841-2454
Practice Address - Country:US
Practice Address - Phone:757-812-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician