Provider Demographics
NPI:1376067348
Name:VASQUEZ, GEORGINA A
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:A
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GEORGINA
Other - Middle Name:A
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLPA
Mailing Address - Street 1:305 NE LOOP 820 BUSINESS TOWER 1
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:1505 CALLE DEL NORTE
Practice Address - Street 2:SUITE 440
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-722-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX395952355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty