Provider Demographics
NPI:1346802295
Name:TACO VASQUEZ, ERIKA DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:DANIELA
Last Name:TACO VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
Mailing Address - Street 2:2799 W GRAND BOULEVARD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-8445
Mailing Address - Fax:313-916-9434
Practice Address - Street 1:HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
Practice Address - Street 2:2799 W GRAND BOULEVARD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8445
Practice Address - Fax:313-916-9434
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351044588390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program