Provider Demographics
NPI:1841558061
Name:VASQUEZ, SOFIA (BS/MS OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:SOFIA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:BS/MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11169
Mailing Address - Country:US
Mailing Address - Phone:718-375-9506
Mailing Address - Fax:
Practice Address - Street 1:346 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3518
Practice Address - Country:US
Practice Address - Phone:718-375-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015436283X00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No283X00000XHospitalsRehabilitation Hospital