Provider Demographics
NPI:1669503744
Name:CYNTHIA T. VAZQUEZ
Entity Type:Organization
Organization Name:CYNTHIA T. VAZQUEZ
Other - Org Name:PRECIOUS GARDEN PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:TREVINO
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-722-9311
Mailing Address - Street 1:1817 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3306
Mailing Address - Country:US
Mailing Address - Phone:956-722-9311
Mailing Address - Fax:956-723-8616
Practice Address - Street 1:1817 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3306
Practice Address - Country:US
Practice Address - Phone:956-722-9311
Practice Address - Fax:956-723-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008323251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185456401Medicaid
TX001015507Medicaid
TX001012398Medicaid
TX001012395Medicaid
TX001012397Medicaid