Provider Demographics
NPI:1740386895
Name:VASQUEZ, MANUEL O (NP)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:O
Last Name:VASQUEZ
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Gender:M
Credentials:NP
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Mailing Address - Street 1:6200 SAVOY DR STE 540
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3338
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:6800 WEST LOOP S STE 560
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4516
Practice Address - Country:US
Practice Address - Phone:713-839-7111
Practice Address - Fax:713-839-7156
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-03-28
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Provider Licenses
StateLicense IDTaxonomies
TX609964363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L14378Medicare PIN