Provider Demographics
NPI:1093226722
Name:VAZQUEZ VASQUEZ, YADAMIS
Entity Type:Individual
Prefix:
First Name:YADAMIS
Middle Name:
Last Name:VAZQUEZ VASQUEZ
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 1:14331 SW 258TH LN APT 3106
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6764
Mailing Address - Country:US
Mailing Address - Phone:786-738-4056
Mailing Address - Fax:
Practice Address - Street 1:14331 SW 258TH LN APT 3106
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6764
Practice Address - Country:US
Practice Address - Phone:786-738-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician