Provider Demographics
NPI:1710128814
Name:VASQUEZ, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name: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:PO BOX 770291
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0005
Mailing Address - Country:US
Mailing Address - Phone:954-822-2876
Mailing Address - Fax:
Practice Address - Street 1:5541 NW 112TH AVE
Practice Address - Street 2:# 304
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4125
Practice Address - Country:US
Practice Address - Phone:954-822-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-05-1979103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst