Provider Demographics
NPI:1326681933
Name:VAZQUEZ GARCIA, BRENDALIZ
Entity Type:Individual
Prefix:
First Name:BRENDALIZ
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:PO BOX 879455
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-9455
Mailing Address - Country:US
Mailing Address - Phone:907-315-5034
Mailing Address - Fax:
Practice Address - Street 1:8691 N WASILLA FISHHOOK RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9077
Practice Address - Country:US
Practice Address - Phone:907-315-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-19-97095374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician