Provider Demographics
NPI:1154822393
Name:VAZQUEZ, IVONNE DANIELLE
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:DANIELLE
Last Name:VAZQUEZ
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 1:3901 PELICAN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5914
Mailing Address - Country:US
Mailing Address - Phone:956-664-0154
Mailing Address - Fax:
Practice Address - Street 1:2609 NESSUH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-4814
Practice Address - Country:US
Practice Address - Phone:956-630-1116
Practice Address - Fax:877-626-0431
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332569164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse