Provider Demographics
NPI:1326368465
Name:VASQUEZ LOARTE, TANIA CATALINA (MC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:CATALINA
Last Name:VASQUEZ LOARTE
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE MAESTRO CHUECA 142
Mailing Address - Street 2:
Mailing Address - City:SAN BORJA
Mailing Address - State:LIMA
Mailing Address - Zip Code:41
Mailing Address - Country:PE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAESTRO CHUECA 142
Practice Address - Street 2:
Practice Address - City:SAN BORJA
Practice Address - State:LIMA
Practice Address - Zip Code:41
Practice Address - Country:PE
Practice Address - Phone:011511-223-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ51750208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice