Provider Demographics
NPI:1780195685
Name:VAZQUEZ, JOSE F
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:F
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ROCK BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-0956
Mailing Address - Country:US
Mailing Address - Phone:775-499-5525
Mailing Address - Fax:
Practice Address - Street 1:1200 ROCK BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-0956
Practice Address - Country:US
Practice Address - Phone:775-499-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician