Provider Demographics
NPI:1326781386
Name:VAZQUEZ, CARLOS ARIEL (NP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ARIEL
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 SANTA ADRIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7498
Mailing Address - Country:US
Mailing Address - Phone:575-494-1054
Mailing Address - Fax:
Practice Address - Street 1:1020 S 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4007
Practice Address - Country:US
Practice Address - Phone:575-936-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM67783363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care