Provider Demographics
NPI:1164893822
Name:VASQUEZ, MILAGROS OLGA
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:OLGA
Last Name: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 1:3137 70TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1716
Mailing Address - Country:US
Mailing Address - Phone:917-365-8130
Mailing Address - Fax:
Practice Address - Street 1:3137 70TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1716
Practice Address - Country:US
Practice Address - Phone:917-365-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst