Provider Demographics
NPI:1578168670
Name:VASQUEZ, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 FOUR IRON CT
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-6620
Mailing Address - Country:US
Mailing Address - Phone:323-303-1414
Mailing Address - Fax:
Practice Address - Street 1:300 LOS ALTOS PKWY STE 109
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7754
Practice Address - Country:US
Practice Address - Phone:775-996-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician