Provider Demographics
NPI:1275033466
Name:VAZQUEZ GARCIA, GRETHEL
Entity Type:Individual
Prefix:
First Name:GRETHEL
Middle Name:
Last Name:VAZQUEZ GARCIA
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 1:6575 W 4TH AVE APT 506
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6658
Mailing Address - Country:US
Mailing Address - Phone:786-731-9878
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST STE 204
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5922
Practice Address - Country:US
Practice Address - Phone:305-406-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-21-55470103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician