Provider Demographics
NPI:1497206528
Name:VASQUEZ YAMBO, AWILDA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AWILDA
Middle Name:
Last Name:VASQUEZ YAMBO
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 1:60 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3411
Mailing Address - Country:US
Mailing Address - Phone:201-640-5428
Mailing Address - Fax:
Practice Address - Street 1:561 E 28TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1862
Practice Address - Country:US
Practice Address - Phone:201-640-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00156600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist