Provider Demographics
NPI:1619649993
Name:FERNANDEZ-VAZQUEZ, NAYROBIS
Entity Type:Individual
Prefix:
First Name:NAYROBIS
Middle Name:
Last Name:FERNANDEZ-VAZQUEZ
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 1:295 NW 72ND AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4342
Mailing Address - Country:US
Mailing Address - Phone:786-569-4795
Mailing Address - Fax:
Practice Address - Street 1:295 NW 72ND AVE APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4342
Practice Address - Country:US
Practice Address - Phone:786-569-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician