Provider Demographics
NPI:1629340641
Name:VASQUEZ, ALBERTO
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MEXICO BLVD STE G4
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4110
Mailing Address - Country:US
Mailing Address - Phone:956-504-9444
Mailing Address - Fax:956-504-9945
Practice Address - Street 1:301 MEXICO BLVD STE G4
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4110
Practice Address - Country:US
Practice Address - Phone:956-504-9444
Practice Address - Fax:956-504-9945
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599162279G1100X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174442701Medicaid