Provider Demographics
NPI:1164008421
Name:VAZQUEZ, MAIDA FELICIA
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:FELICIA
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 1:8180 NW 36TH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6660
Mailing Address - Country:US
Mailing Address - Phone:786-334-6946
Mailing Address - Fax:786-313-3079
Practice Address - Street 1:8180 NW 36TH ST STE 307
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6660
Practice Address - Country:US
Practice Address - Phone:786-334-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-147566106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-147566OtherBACB CERTIFICATION