Provider Demographics
NPI:1497135396
Name:VAZQUEZ, GLORIA MARIA (BA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 FUTURES DR
Mailing Address - Street 2:105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9090
Mailing Address - Country:US
Mailing Address - Phone:407-730-7983
Mailing Address - Fax:407-985-3678
Practice Address - Street 1:7500 FUTURES DR
Practice Address - Street 2:105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9090
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:407-985-3678
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator