Provider Demographics
NPI:1043764111
Name:VASQUEZ, RHONDA (LMT, EEM-CLP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LMT, EEM-CLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 65 BOX 276
Mailing Address - Street 2:
Mailing Address - City:KANARRAVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84742-6503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 W ROYAL HUNTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1800
Practice Address - Country:US
Practice Address - Phone:435-590-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7718217-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist