Provider Demographics
NPI:1881206027
Name:VASQUEZ, MIRNA ARACELIS (MD)
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:ARACELIS
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 E 174TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-1733
Mailing Address - Country:US
Mailing Address - Phone:917-428-0524
Mailing Address - Fax:
Practice Address - Street 1:1691 E 174TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1733
Practice Address - Country:US
Practice Address - Phone:917-428-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist