Provider Demographics
NPI:1790442994
Name:VAZQUEZ, DIANA PAOLA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PAOLA
Last Name:VAZQUEZ
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 1:9012 AVENUE POINTE CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6373
Mailing Address - Country:US
Mailing Address - Phone:520-442-5064
Mailing Address - Fax:
Practice Address - Street 1:9012 AVENUE POINTE CIR APT 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-6373
Practice Address - Country:US
Practice Address - Phone:520-442-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist