Provider Demographics
NPI:1518002237
Name:JAIME J. VASQUEZ, D.O., P.A.
Entity Type:Organization
Organization Name:JAIME J. VASQUEZ, D.O., P.A.
Other - Org Name:VASQUEZ CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-528-1083
Mailing Address - Street 1:2929 WELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4931
Mailing Address - Country:US
Mailing Address - Phone:214-528-1083
Mailing Address - Fax:214-528-3252
Practice Address - Street 1:2929 WELBORN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4931
Practice Address - Country:US
Practice Address - Phone:214-528-1083
Practice Address - Fax:214-528-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4764261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G10JMedicare ID - Type Unspecified
TXE23542Medicare UPIN