Provider Demographics
NPI:1578335980
Name:VAZQUEZ VAZQUEZ, GEIDY (RBT)
Entity Type:Individual
Prefix:
First Name:GEIDY
Middle Name:
Last Name:VAZQUEZ VAZQUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 W 35TH CT APT 5310
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2153
Mailing Address - Country:US
Mailing Address - Phone:786-493-6613
Mailing Address - Fax:
Practice Address - Street 1:13170 SW 128TH ST STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5845
Practice Address - Country:US
Practice Address - Phone:786-382-0550
Practice Address - Fax:786-705-6742
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-306555106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician