Provider Demographics
NPI:1538664677
Name:VAZQUEZ ARREOLA, ISAURA (COTA)
Entity Type:Individual
Prefix:
First Name:ISAURA
Middle Name:
Last Name:VAZQUEZ ARREOLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 W PORT ROYALE LN
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-6950
Mailing Address - Country:US
Mailing Address - Phone:623-329-1245
Mailing Address - Fax:
Practice Address - Street 1:11909 W PORT ROYALE LN
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-6950
Practice Address - Country:US
Practice Address - Phone:623-329-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6751224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6751Medicaid