Provider Demographics
NPI:1467065508
Name:ORTEGA VAZQUEZ, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:ORTEGA VAZQUEZ
Suffix:
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 1:13835 SW 274TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8830
Mailing Address - Country:US
Mailing Address - Phone:786-294-7718
Mailing Address - Fax:
Practice Address - Street 1:13835 SW 274TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8830
Practice Address - Country:US
Practice Address - Phone:786-294-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician