Provider Demographics
NPI:1477326130
Name:VASQUEZ, RAQUEL (LMT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 SUNLAND PARK DR # 200
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5114
Mailing Address - Country:US
Mailing Address - Phone:915-296-5900
Mailing Address - Fax:
Practice Address - Street 1:664 SUNLAND PARK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5114
Practice Address - Country:US
Practice Address - Phone:915-296-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist