Provider Demographics
NPI:1407155393
Name:VASQUEZ, REBECCA (SA-C)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12436 FM 1960 RD W
Mailing Address - Street 2:SUITE 171
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4809
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:12436 FM 1960 RD W
Practice Address - Street 2:SUITE 171
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4809
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:832-478-9266
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT009639225700000X
TX10-248246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant