Provider Demographics
NPI:1629643564
Name:VASQUEZ, CRYSTAL MARIAH (PA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIAH
Last Name:VASQUEZ
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Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5504 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3183
Mailing Address - Country:US
Mailing Address - Phone:505-348-2868
Mailing Address - Fax:
Practice Address - Street 1:5504 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3183
Practice Address - Country:US
Practice Address - Phone:505-348-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2022-09-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant