Provider Demographics
NPI:1568524270
Name:VAZQUEZ, RANDI (MS)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 S SANDHILL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2550
Mailing Address - Country:US
Mailing Address - Phone:702-451-4530
Mailing Address - Fax:
Practice Address - Street 1:5755 S SANDHILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2550
Practice Address - Country:US
Practice Address - Phone:702-451-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0503106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist