Provider Demographics
NPI:1316410749
Name:VAZQUEZ-GUAL, CHASTITI HILL
Entity Type:Individual
Prefix:
First Name:CHASTITI
Middle Name:HILL
Last Name:VAZQUEZ-GUAL
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 1:4495 PAGOSA SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8306
Mailing Address - Country:US
Mailing Address - Phone:787-391-2123
Mailing Address - Fax:
Practice Address - Street 1:6520 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5703
Practice Address - Country:US
Practice Address - Phone:321-622-8792
Practice Address - Fax:321-622-8793
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty