Provider Demographics
NPI:1164917654
Name:VASQUEZ ENCINAS, NESTOR ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:ENRIQUE
Last Name:VASQUEZ ENCINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-648-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-04-16
Deactivation Date:2019-02-13
Deactivation Code:
Reactivation Date:2019-04-10
Provider Licenses
StateLicense IDTaxonomies
TXBP10063679390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program