Provider Demographics
NPI:1043395114
Name:VASQUEZ, CELINA G (OD)
Entity Type:Individual
Prefix:DR
First Name:CELINA
Middle Name:G
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W PALMA VISTA DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2126
Mailing Address - Country:US
Mailing Address - Phone:956-519-3350
Mailing Address - Fax:956-519-3866
Practice Address - Street 1:207 W PALMA VISTA DR
Practice Address - Street 2:SUITE I
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-2126
Practice Address - Country:US
Practice Address - Phone:956-519-3350
Practice Address - Fax:956-519-3866
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5398T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0929929-02Medicaid
TX0929929-02Medicaid
TXU71234Medicare UPIN