Provider Demographics
NPI:1083464978
Name:VAZQUEZ, FELIPE G
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:G
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BLANCO RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3847
Mailing Address - Country:US
Mailing Address - Phone:210-737-9230
Mailing Address - Fax:210-737-9644
Practice Address - Street 1:301 BLANCO RD STE B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3847
Practice Address - Country:US
Practice Address - Phone:210-737-9230
Practice Address - Fax:210-737-9644
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0093633747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680591003Medicaid
TX1659425056Medicaid