Provider Demographics
NPI:1366860405
Name:QUINTANA-VAZQUEZ, YUISA (MA 60449738)
Entity Type:Individual
Prefix:
First Name:YUISA
Middle Name:
Last Name:QUINTANA-VAZQUEZ
Suffix:
Gender:F
Credentials:MA 60449738
Other - Prefix:
Other - First Name:YUISA
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10612 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373
Mailing Address - Country:US
Mailing Address - Phone:253-302-4817
Mailing Address - Fax:253-507-4381
Practice Address - Street 1:2717 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3165
Practice Address - Country:US
Practice Address - Phone:253-279-0424
Practice Address - Fax:253-693-2201
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60449738174400000X
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist