Provider Demographics
NPI:1235182908
Name:VAZQUEZ-RENTAS, JOSEFA (RD,CDN)
Entity Type:Individual
Prefix:MS
First Name:JOSEFA
Middle Name:
Last Name:VAZQUEZ-RENTAS
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:MS
Other - First Name:JOSEFA
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,CDN
Mailing Address - Street 1:565 85TH ST
Mailing Address - Street 2:APT B40
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4863
Mailing Address - Country:US
Mailing Address - Phone:718-836-6600
Mailing Address - Fax:
Practice Address - Street 1:565 85TH ST
Practice Address - Street 2:APT B40
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4863
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48004097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY48004097OtherDIETITIAN/NUTRITIONIST