Provider Demographics
NPI:1235685991
Name:VAZQUEZ, DIANA I
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VAZQUEZ
Suffix:I
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 1:6605 PASEO REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3231
Mailing Address - Country:US
Mailing Address - Phone:915-626-9024
Mailing Address - Fax:
Practice Address - Street 1:6605 PASO REDONDO AVE.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3231
Practice Address - Country:US
Practice Address - Phone:915-626-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLHOC16-00070311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home