Provider Demographics
NPI:1942431218
Name:VAZQUEZ, OMAYDA
Entity Type:Individual
Prefix:
First Name:OMAYDA
Middle Name:
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 1:601 LIMONA RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2828
Mailing Address - Country:US
Mailing Address - Phone:786-624-7194
Mailing Address - Fax:
Practice Address - Street 1:601 LIMONA RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2828
Practice Address - Country:US
Practice Address - Phone:786-624-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44609225700000X
FL0-19-10311106E00000X
FL1-21-53559103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst