Provider Demographics
NPI:1912574112
Name:VAZQUEZ-PARTIDA, JULISSA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:DEL CARMEN
Last Name:VAZQUEZ-PARTIDA
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 1:1625 E PRATER WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8963
Mailing Address - Country:US
Mailing Address - Phone:775-359-7585
Mailing Address - Fax:775-391-5988
Practice Address - Street 1:1625 E PRATER WAY STE 103
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8963
Practice Address - Country:US
Practice Address - Phone:775-359-7585
Practice Address - Fax:775-391-5988
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10291225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist