Provider Demographics
NPI:1811552094
Name:VASQUEZ, GILDA (LNFA)
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 MOONLIT LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5972
Mailing Address - Country:US
Mailing Address - Phone:832-315-1339
Mailing Address - Fax:
Practice Address - Street 1:3132 MOONLIT LAKE CIR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5972
Practice Address - Country:US
Practice Address - Phone:832-315-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11083376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator