Provider Demographics
NPI:1093968919
Name:VASQUEZ, REBECCA DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DAWN
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:DAWN
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3904 BELMONT STABLES LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1334
Mailing Address - Country:US
Mailing Address - Phone:512-947-1897
Mailing Address - Fax:512-487-5376
Practice Address - Street 1:11700 WESTHEIMER RD STE J
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6884
Practice Address - Country:US
Practice Address - Phone:713-456-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant