Provider Demographics
NPI:1679346720
Name:LIRANZO VASQUEZ, SELENNY
Entity Type:Individual
Prefix:
First Name:SELENNY
Middle Name:
Last Name:LIRANZO VASQUEZ
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 1:850 E 164TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3021
Mailing Address - Country:US
Mailing Address - Phone:929-562-7212
Mailing Address - Fax:
Practice Address - Street 1:850 E 164TH ST APT 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3021
Practice Address - Country:US
Practice Address - Phone:917-260-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program