Provider Demographics
NPI:1194374090
Name:VAZQUEZ, IRENE GUADALUPE (RN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:GUADALUPE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-2499
Mailing Address - Country:US
Mailing Address - Phone:602-455-6700
Mailing Address - Fax:602-278-1693
Practice Address - Street 1:3348 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2499
Practice Address - Country:US
Practice Address - Phone:602-455-6700
Practice Address - Fax:602-278-1693
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN212695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse