Provider Demographics
NPI:1376226118
Name:VAZQUEZ, RULY CESAR JR
Entity Type:Individual
Prefix:
First Name:RULY
Middle Name:CESAR
Last Name:VAZQUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6337
Mailing Address - Country:US
Mailing Address - Phone:786-818-1565
Mailing Address - Fax:
Practice Address - Street 1:6580 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6337
Practice Address - Country:US
Practice Address - Phone:786-818-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-278838106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician