Provider Demographics
NPI:1326447228
Name:VAZQUEZ, DELIANA
Entity Type:Individual
Prefix:
First Name:DELIANA
Middle Name:
Last Name:VAZQUEZ
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 1:10145 NW 9TH STREET CIR APT 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3279
Mailing Address - Country:US
Mailing Address - Phone:305-846-0925
Mailing Address - Fax:305-248-6558
Practice Address - Street 1:10145 NW 9TH STREET CIR APT 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3279
Practice Address - Country:US
Practice Address - Phone:305-846-0925
Practice Address - Fax:305-248-6558
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 2089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist